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There is mounting interest in the dual health and environmental benefits of plant-based diets. Such diets prioritise whole foods of plant origin and moderate (though occasionally exclude) animal-sourced foods. However, the evidence base on plant-based diets and health outcomes in Australasia is limited and diverse, making it unsuitable for systematic review. This review aimed to assess the current state of play, identify research gaps and suggest good practice recommendations. The consulted evidence base included key studies on plant-based diets and cardiometabolic health or mortality outcomes in Australian and New Zealand adults. Most studies were observational, conducted in Australia, published within the last decade, and relied on a single dietary assessment about 10–30 years ago. Plant-based diets were often examined using categories of vegetarianism, intake of plant or animal protein, or dietary indices. Health outcomes included mortality, type 2 diabetes and insulin resistance, obesity, CVD and metabolic syndrome. While Australia has an emerging and generally favourable evidence base on plant-based diets and health outcomes, New Zealand’s evidence base is still nascent. The lack of similar studies hinders the ability to judge the overall certainty of evidence, which could otherwise inform public health policies and strategies without relying on international studies with unconfirmed applicability. The proportional role of plant- and animal-sourced foods in healthy, sustainable diets in Australasia is an underexplored research area with potentially far-reaching implications, especially concerning nutrient adequacy and the combined health and environmental impacts.
Dietary guidelines are increasingly promoting mostly plant-based diets, limits on red meat consumption, and plant-based sources of protein for health and environmental reasons. It is unclear how the resulting food substitutions associate with insulin resistance, a risk factor for type 2 diabetes. We modelled the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity. We included 783 participants (55 % female) from the Childhood Determinants of Adult Health study, a population-based cohort of Australians. In adulthood, diet was assessed at three time points using FFQ: 2004–2006, 2009–2011 and 2017–2019. We calculated the average daily intake of each food group in standard serves. Insulin sensitivity was estimated from fasting glucose and insulin concentrations in 2017–2019 (aged 39–49 years) using homoeostasis model assessment. Replacing red meat with a combination of plant-based alternatives was associated with higher insulin sensitivity (β = 10·5 percentage points, 95 % CI (4·1, 17·4)). Adjustment for waist circumference attenuated this association by 61·7 %. Replacing red meat with either legumes, nuts/seeds or wholegrains was likewise associated with higher insulin sensitivity. Point estimates were similar but less precise when replacing processed meat with plant-based alternatives. Our modelling suggests that regularly replacing red meat, and possibly processed meat, with plant-based alternatives may associate with higher insulin sensitivity. Further, abdominal adiposity may be an important mediator in this relationship. Our findings support advice to prioritise plant-based sources of protein at the expense of red meat consumption.
Outdoor activities have accelerated in the past several years. The authors were tasked with providing medical care for the Union Cycliste International (UCI) mountain biking World Cup in Snowshoe, West Virginia (USA) in September 2021. The Hartman and Arbon models were designed to predict patient presentation and hospital transport rates as well as needed medical resources at urban mass-gathering events. However, there is a lack of standardized methods to predict injury, illness, and insult severity at rural mass gatherings.
Study Objective:
This study aimed to determine whether the Arbon model would predict, within 10%, the number of patient presentations to be expected and to determine if the event classification provided by the Hartman model would adequately predict resources needed during the event.
Methods:
Race data were collected from UCI event officials and injury data were collected from participants at time of presentation for medical care. Predicted presentation and transport rates were calculated using the Arbon model, which was then compared to the actual observed presentation rates. Furthermore, the event classification provided by the Hartman model was compared to the resources utilized during the event.
Results:
During the event, 34 patients presented for medical care and eight patients required some level of transport to a medical facility. The Arbon predictive model for the 2021 event yielded 30.3 expected patient presentations. There were 34 total patient presentations during the 2021 race, approximately 11% more than predicted. The Hartman model yielded a score of four. Based on this score, this race would be classified as an “intermediate” event, requiring multiple Advanced Life Support (ALS) and Basic Life Support (BLS) personnel and transport units.
Conclusion:
The Arbon model provided a predicted patient presentation rate within reasonable error to allow for effective pre-event planning and resource allocation with only a four patient presentation difference from the actual data. While the Arbon model under-predicted patient presentations, the Hartman model under-estimated resources needed due to the high-risk nature of downhill cycling. The events staffed required physician skills and air medical services to safely care for patients. Further evaluation of rural events will be needed to determine if there is a generalized need for physician presence at smaller events with inherently risky activities, or if this recurring cycling event is an outlier.
Variation in delineation of target volumes/organs at risk (OARs) is well recognised in radiotherapy and may be reduced by several methods including teaching. We evaluated the impact of teaching on contouring variation for thoracic/pelvic stereotactic ablative radiotherapy (SABR) during a virtual contouring workshop.
Materials and methods:
Target volume/OAR contours produced by workshop participants for three cases were evaluated against reference contours using DICE similarity coefficient (DSC) and line domain error (LDE) metrics. Pre- and post-workshop DSC results were compared using Wilcoxon signed ranks test to determine the impact of teaching during the workshop.
Results:
Of 50 workshop participants, paired pre- and post-workshop contours were available for 21 (42%), 20 (40%) and 22 (44%) participants for primary lung cancer, pelvic bone metastasis and pelvic node metastasis cases, respectively. Statistically significant improvements post-workshop in median DSC and LDE results were observed for 6 (50%) and 7 (58%) of 12 structures, respectively, although the magnitude of DSC/LDE improvement was modest in most cases. An increase in median DSC post-workshop ≥0·05 was only observed for GTVbone, IGTVlung and SacralPlex, and reduction in median LDE > 1 mm was only observed for GTVbone, CTVbone and SacralPlex. Post-workshop, median DSC values were >0·7 for 75% of structures. For 92% of the structures, post-workshop contours were considered to be acceptable or within acceptable variation following review by the workshop faculty.
Conclusions:
This study has demonstrated that virtual SABR contouring training is feasible and was associated with some improvements in contouring variation for multiple target volumes/OARs.
Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. Although psychological therapies for suicidal behaviour are effective in out-patient settings, there is little research on their effectiveness for in-patients who are suicidal.
Aims
Our primary objective was to determine whether cognitive–behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared with treatment as usual (TAU) for in-patients who are suicidal. Secondary aims were to assess the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide.
Method
A single-blind pilot randomised controlled trial comparing TAU to TAU plus CBSP in in-patients in acute psychiatric wards who are suicidal (the Inpatient Suicide Intervention and Therapy Evaluation (INSITE) trial, trial registration: ISRCTN17890126). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline and at 6 weeks and 6 months post-baseline.
Results
A total of 51 individuals were randomised (27 to TAU, 24 to TAU plus CBSP) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus CBSP). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for in-patients who are acutely suicidal was feasible and acceptable while on in-patient wards and following discharge. Economic analysis suggests the intervention could be cost-effective.
Discussion
Psychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.
Declaration of interest
The trial was hosted by Greater Manchester Mental health NHS Trust (formerly, Manchester Mental Health and Social Care NHS Trust). The authors are affiliated to the University of Manchester, Greater Manchester Mental Health Foundation Trust, Lancashire Care NHS Foundation trust and the Manchester Academic Health Sciences Centre. Y.A. is a trustee for a North-West England branch of the charity Mind.
Although the rumen fluke, Calicophoron daubneyi is now very common and widespread throughout Western Europe, reports of clinical cases are still rare. This study explores the epidemiological background to a severe rumen fluke outbreak in 6-month-old heifers on a dairy farm in Ireland. Sequence analysis of the cytochrome oxidase subunit 1 (Cox1) gene of the rumen fluke metacercariae on pasture failed to identify predominant, possibly pathogenic subtypes. However, estimates of metacercarial load indicated that the animals were exposed to a daily dose of about 5334 C. daubneyi metacercariae for a period of 3 weeks resulting in the build-up of very large numbers of immature worms in the small intestine. It is hypothesized that specific environmental conditions may favour this parasite over its competitor, the liver fluke, Fasciola hepatica, possibly by allowing it to emerge earlier. The possibility that C. daubneyi may be better adapted to the Irish climate than F. hepatica together with the fact that selective treatment against F. hepatica effectively frees the niche for C. daubneyi, may result in the gradual replacement of F. hepatica by C. daubneyi.
Miconia (Miconia calvescens DC.) is a tropical tree species from South and Central America that is a highly invasive colonizer of Hawaii's forested watersheds. Elimination of satellite populations is critical to an effective containment strategy, but extreme topography limits accessibility to remote populations by helicopter operations only. Herbicide Ballistic Technology (HBT) is a novel weed control tool designed to pneumatically deliver encapsulated herbicide projectiles. It is capable of accurately treating miconia satellites within a 30 m range in either horizontal or vertical trajectories. Efficacy was examined for the encapsulated herbicide projectiles, each containing 199.4 mg ae triclopyr, when applied to miconia in 5-unit increments. Experimental calibrations of the HBT platform were recorded on a Hughes 500-D helicopter while conducting surveillance operations from November 2010 through October 2011 on the islands of Maui and Kauai. Search efficiency (min ha−1; n = 13, R2 = 0.933, P< 0.001) and target acquisition rate (plants hr−1, n = 13, R2 = 0.926, P< 0.001) displayed positive linear and logarithmic relationships, respectively, to plant target density. The search efficiency equation estimated target acquisition time at 25.1 sec and a minimum surveillance rate of 67.8 s ha−1 when no targets were detected. The maximum target acquisition rate for the HBT platform was estimated at 143 targets hr−1. An average mortality factor of 0.542 was derived from the product of detection efficacy (0.560) and operational treatment efficacy (0.972) in overlapping buffer areas generated from repeated flight segments (n = 5). This population reduction value was used in simulation models to estimate the expected costs for one- and multi-year satellite population control strategies for qualifying options in cost optimization and risk aversion. This is a first report on the performance of an HBT helicopter platform demonstrating the capability for immediate, rapid-response control of new satellite plant detections, while conducting aerial surveillance of incipient miconia populations.
The miconia (Miconia calvescens) invasion of the East Maui Watershed (EMW) started from a single introduction over 40 yr ago, establishing a nascent patch network spread across 20,000 ha. In 2012, an accelerated intervention strategy was implemented utilizing the Herbicide Ballistic Technology (HBT) platform in a Hughes 500D helicopter to reduce target densities of seven nascent patches in the EMW. In a 14-mo period, a total of 48 interventions eliminated 4,029 miconia targets, with an estimated 33% increase in operations and 168% increase in recorded targets relative to the adjusted means from 2005 to 2011 data (prior to HBT adoption). This sequence of interventions covered a total net area of 1,138 ha, creating a field mosaic of overlapping search coverage (saturation) for each patch (four to eight interventions per patch). Target density reduction for each patch fit exponential decay functions (R2 > 0.88, P < 0.05), with a majority of the target interventions spatially assigned to the highest saturation fields. The progressive decay in target density led to concomitant reductions in search efficiency (min ha−1) and herbicide use rate (grams ae ha−1) in subsequent interventions. Mean detection efficacy (± SE) between overlapping interventions (n = 41) was 0.62 ± 0.03, matching closely with the probability of detection for a random search operation and verifying imperfect (albeit precise) detection. The HBT platform increases the value of aerial surveillance operations with 98% efficacy in target elimination. Applying coverage saturation with an accelerated intervention schedule to known patch locations is an adaptive process for compensating imperfect detection and building intelligence with spatial and temporal relevance to the next operation.
The Iranian military intervention in Oman (1972–75) proved to be one of Shah Mohammad Reza Pahlavi's most successful foreign policy initiatives. He entered at the request of Sultan Qabus to help quell the Marxist rebellion of the Popular Front for the Liberation of Oman in Dhufar province. The shah took this action without any prior consultation with either Britain or the United States, acting for reasons wholly related to Iran's regional security. In so doing, he angered most of his Arab neighbors, who protested vigorously. He persisted. His troops tipped the balance in favor of the sultan's forces, contributing to a speedy end to the insurrection, for which Iran earned the lasting gratitude of the sultan.
In his study Modernity and the Holocaust, Zygmunt Bauman contrasts the hopes and expectations of the modernising world of the nineteenth century with the real outcomes of the twentieth century, where the very conditions of modernity have led to the mass destruction of humanity and of those early hopes for the betterment of humankind. This volume explores the possibilities left to those once modernising societies, not only in terms of the worlds they have constructed but also in discerning the novel conditions which the closure of modernity entails. That closure, in part the completion of industrialisation and the social order that went with it, and in part the dislocation of the kinds of social knowledge used to understand it, has raised profound and disturbing questions about the character of this brave new world and the ways in which its governance and the goal of the good society can be understood. This volume explores some of the current vicissitudes of modernity, especially in relation to the crises of the political, and the political consequences of new technologies.
Preterm birth can affect many neurological functions and is known to affect vision when damage to the visual cortex or optic radiations occurs. However, it is not known whether extreme preterm birth affects visual development, either favorably or unfavorably. Additional time in an extrauterine environment could conceivably allow the acceleration of visual abilities as a result of additional experience. Although recent studies suggest that even apparently healthy preterm infants may suffer some degree of loss of neurological function. In this paper we describe what is known about visual development in preterm infants, and we make the case that additional studies are needed to clarify the impact of preterm birth on vision. Because the visual system now lends itself to quantitative studies of function, it could offer researchers and clinicians a method of detecting subtle effects of preterm birth on neurological development and function.
The deformation of polymer films under repetitive contact at high strain rates was investigated using nanoscale impact testing. Four systems were studied: (i) rubber-modified acrylonitrile-butadiene-styrene (ABS) (0–25 wt% rubber), (ii) uniaxially and biaxially drawn poly(ethylene terephthalate) film; (iii) poly(ethylene oxide)–clay nanocomposites, and (iv) nylon 6–organoclay nanocomposites. The initial results suggest that the technique has much potential in evaluating the fatigue behavior of thinner polymer films and coatings that are unsuitable for conventional methods designed for bulk samples. The extent of impact-induced deformation may be used as a measure of ductility because ductile failures are associated with significant plastic deformation before failure whereas brittle failures usually involve little plastic deformation. The nano-impact technique provides valuable highly localized information about deformation under high strain rate, which is complementary to low strain rate tests such as nanoindentation and nano-scratch. The technique has been shown to be sensitive to nano-/microstructural variations in ABS–rubber film when Berkovich indenters and low impact forces were used. The impact behavior of the nanocomposites is only significantly worse than that of the virgin polymers at the highest clay loading studied (15 wt%). This could be a factor when assessing the suitability of novel nanocomposite materials for applications where toughness is important. On ABS film, there is only an approximate correlation between the plastic work function determined from nanoindentation and the rubber loading in the film while the correlation between the rubber loading and nano-impact data is clear, suggesting that the dynamic test is a more useful predictor of thin polymer film toughness than the slow-loading quasi-static indentation test.
A 21-year-old male presented with occipital lobes that were extensively damaged by bilateral infarcts present at birth. The absence of the striate cortex was confirmed with anatomic and functional MRI and high-resolution EEG. His cortical visual impairment was severe, but he retained a remarkable ability to see fast-moving stimuli. Horizontal optokinetic nystagmus could be elicited from either eye. Resolution acuity was close to normal providing the patient was allowed to move his head and eyes. The direction of motion in random-dot patterns could be discriminated with perfect accuracy at speeds above 2 deg/s, and the patient reported that he could ‘see’ the motion at fast but not at slow speeds. This conscious residual vision for motion is known as Riddoch's phenomenon, but it has never been reported in the complete absence of the striate cortex. Functional neuroimaging revealed activation that was outside the motion-responsive regions of the extrastriate cortex. This case demonstrates remarkable plasticity in the human visual system and may have implications for understanding the functional organization of the motion pathways.