Introduction: Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. We conducted a systematic review to determine the effect of digital technology distraction on pain and distress for children experiencing acutely painful conditions or medical procedures. Methods: We searched eight online databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, IEEE Xplore, Ei Compendex, Web of Science), grey literature sources, scanned reference lists, and contacted experts for quantitative studies where digital technologies were used as distraction for acutely painful conditions or procedures in children. Study selection was performed by two independent reviewers with consensus. One reviewer extracted relevant study data and another verified it for accuracy. Appraisal of risk of bias within studies and the certainty of the body of evidence were performed independently in duplicate, with the final appraisal determined by consensus. The primary outcomes of interest were child pain and distress. Results: Of 3247 unique records identified by the search, we included 106 studies (n = 7820) that reported on digital technology distractors (e.g., virtual reality; videogames) used during common procedures (e.g., venipuncture, minor dental procedures, burn treatments). We located no studies reporting on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (SMD -0.48, 95% CI -0.66 to -0.29, 46 RCTs, n = 3200), observer-reported pain (SMD -0.68, 95% CI -0.91 to -0.45, 17 RCTs, n = 1199), behavioural pain (SMD -0.57, 95% CI -0.94 to -0.19, 19 RCTs, n = 1173), self-reported distress (SMD -0.49, 95% CI -0.70 to -0.27, 19 RCTs, n = 1818), observer-reported distress (SMD -0.47, 95% CI -0.77 to -0.17, 10 RCTs, n = 826), and behavioural distress (SMD -0.35, 95% CI -0.59 to -0.12, 17 RCTs, n = 1264) compared to usual care. Few studies directly compared different distractors or provided subgroup data to inform applicability. Conclusion: Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over non-digital distractors is not established. Healthcare providers and parents should strongly consider using distractions as a pain-reduction strategy for children and teens during common painful procedures (e.g., needle pokes, dental fillings). Context, child preference, and availability should inform the choice of distractor.

The new mineral feynmanite, Na(UO2)(SO4)(OH)·3.5H2O, was found in both the Blue Lizard and Markey mines, San Juan County, Utah, USA, where it occurs as a secondary phase on pyrite-rich asphaltum in association with chinleite-(Y), gypsum, goethite, natrojarosite, natrozippeite, plášilite, shumwayite (Blue Lizard) and wetherillite (Markey). The mineral is pale greenish yellow with a white streak and fluoresces bright greenish white under a 405 nm laser. Crystals are transparent with a vitreous lustre. It is brittle, with a Mohs hardness of ~2, irregular fracture and one perfect cleavage on {010}. The calculated density is 3.324 g cm–3. Crystals are thin needles or blades, flattened on {010} and elongate on [100], exhibiting the forms {010}, {001}, {101} and {10$\bar{1}$}, and are up to ~0.1 mm in length. Feynmanite is optically biaxial (–), with α = 1.534(2), β = 1.561(2) and γ = 1.571(2) (white light); 2Vmeas. = 62(2)°; no dispersion; and optical orientation: X = b, Y ≈ a,Z ≈ c. It is weakly pleochroic: X = colourless, Y = very pale green yellow and Z = pale green yellow (X < Y < Z). Electron microprobe analyses (WDS mode) provided (Na0.84Fe0.01)(U1.01O2)(S1.01O4)(OH)·3.5H2O. The five strongest powder X-ray diffraction lines are [dobs Å(I)(hkl)]: 8.37(100)(010), 6.37(33)($\bar{1}$01,101), 5.07(27)($\bar{1}$11,111), 4.053(46)(004,021) and 3.578(34)(120). Feynmanite is monoclinic, has space group P2/n, a = 6.927(3), b = 8.355(4), c = 16.210(7) Å, β = 90.543(4)°, V = 938.1(7) Å3 and Z = 4. The structure of feynmanite (R1 = 0.0371 for 1879 Io > 2σI) contains edge-sharing pairs of pentagonal bipyramids that are linked by sharing corners with SO4 groups, yielding a [(UO2)2(SO4)2(OH)2]2– sheet based on the phosphuranylite anion topology. The sheet is topologically identical to those in deliensite, johannite and plášilite. The dehydration of feynmanite to plášilite results in interlayer collapse involving geometric reconfiguration of the sheets and the ordering of Na.

Introduction: Cigarette addiction results from both pharmacological effects of nicotine and the rewarding effects of associated cues, including respiratory tract sensations.

Aims: This study sought to evaluate the initial acceptability of a non-nicotine botanical formulation that provided similar respiratory tract cues.

Methods: Two active test products and matching placebos were evaluated. One test product, an e-cigarette-like device, delivered a visible aerosol upon puffing; the other test product delivered an invisible vapour at ambient temperature. Test products delivered a botanical extract with flavourings and vehicle; the placebos delivered flavourings and vehicle only. Sixteen participants had 3-h ad libitum access to each test product and associated placebos, and were deprived of combustible cigarettes for 1 h before and throughout the 3-h evaluation period. Subjects rated the satisfaction (primary outcome) and other sensory qualities of the products. Safety evaluations included pulmonary function testing and monitoring vital signs.

Results: Satisfaction ratings (seven-point scale) were significantly greater for the active e-cigarette-like condition; M = 3.18, SD = 1.04 versus M = 2.69, SD = 1.22. Safety evaluations showed no clinically significant changes.

Conclusions: The results support the potential acceptability of a non-nicotine cigarette substitute in providing satisfaction to smokers. This approach merits further evaluation for safety and acceptability in tobacco harm reduction and cessation.

A spatially explicit metapopulation neighborhood model was extended to encompass the seed bank dynamics of the annual weed Alopecurus myosuroides Huds. (blackgrass), growing in U.K. winter wheat crops established after noninversion tillage. The effects of the initial spatial pattern of infestation, herbicide, and combine harvesting on seed bank densities and on expected yield losses of the infested crop were studied within a 634 m2 area. In the absence of herbicide, all seed bank populations were large and typical of values in the literature; those with patchy initial distributions spread quickly over the entire field. The effects of intraspecific competition ensured that even after 10 yr, the average seed bank density from three patterns with the same initial density consistently retained the same rank order: the initially uniform pattern consistently ranked largest; a patchily distributed moderate infestation ranked next; a more patchily distributed heavy infestation ranked least. Expected grain yield losses sometimes exceeded 40%. With the introduction of a herbicide, seed densities declined exponentially, but the rank order with regard to spatial pattern remained. Relatively dense patches occasionally persisted for longer than 10 yr. The economic threshold for treatment was achieved within 2 and 5 yr, depending on the infestation pattern, but the model predicted that it would take many more than 10 yr before infestations could be completely eliminated. The effects of harvesting by combine were modeled. In all cases, the speed of the spread of infestation along a row appeared to be largely due to the combine rather than to natural dispersal or other cultivation practices. The proportion of seeds removed by the combine was an important determinant of the number of years required to drive the population below the economic threshold and of the probability of long-term eradication of the weed metapopulation.

Experiments on the National Ignition Facility show that multi-dimensional effects currently dominate the implosion performance. Low mode implosion symmetry and hydrodynamic instabilities seeded by capsule mounting features appear to be two key limiting factors for implosion performance. One reason these factors have a large impact on the performance of inertial confinement fusion implosions is the high convergence required to achieve high fusion gains. To tackle these problems, a predictable implosion platform is needed meaning experiments must trade-off high gain for performance. LANL has adopted three main approaches to develop a one-dimensional (1D) implosion platform where 1D means measured yield over the 1D clean calculation. A high adiabat, low convergence platform is being developed using beryllium capsules enabling larger case-to-capsule ratios to improve symmetry. The second approach is liquid fuel layers using wetted foam targets. With liquid fuel layers, the implosion convergence can be controlled via the initial vapor pressure set by the target fielding temperature. The last method is double shell targets. For double shells, the smaller inner shell houses the DT fuel and the convergence of this cavity is relatively small compared to hot spot ignition. However, double shell targets have a different set of trade-off versus advantages. Details for each of these approaches are described.

Comparing genotype results of tuberculosis (TB) isolates from individuals diagnosed with TB can support or refute transmission; however, these conclusions are based upon the criteria used to define a genotype match. We used a genotype-match definition which allowed for variation in IS6110 restriction fragment length polymorphism (RFLP) to support transmission between epidemiologically linked persons. Contacts of individuals with infectious TB (index cases) diagnosed in New York City from 1997 to 2003 who subsequently developed TB (contact cases) from 1997 to 2007 were identified. For each contact case and index case (case-pair), isolate genotypes (spoligotype and RFLP results) were evaluated. Isolates from case-pairs were classified as exact or non-exact genotype match. Genotypes from non-exact match case-pairs were reviewed at the genotyping laboratory to determine if the isolates met the near-genotype-match criteria (exactly matching spoligotype and similar RFLP banding patterns). Of 118 case-pairs identified, isolates from 83 (70%) had exactly matching genotypes and 14 (12%) had nearly matching genotypes (supporting transmission), while the remaining 21 (18%) case-pairs had discordant genotypes (refuting transmission). Using identical genotype-match criteria for isolates from case-pairs epidemiologically linked through contact investigation may lead to underestimation of transmission. TB programmes should consider the value of expanding genotype-match criteria to more accurately assess transmission between such cases.

Improving neurocognitive outcomes following treatment for brain metastases have become increasingly important. We propose that a brief telephone-based neurocognitive assessment may improve follow-up cognitive assessments in this palliative population. Aim: To prospectively assess the feasibility and reliability of a telephone based brief neurocognitive assessment compared to the same tests delivered face-to-face. Methods: Brain metastases patients to be treated with whole brain radiotherapy (WBRT) were assessed using a brief validated neurocognitive battery at baseline, at 1 month and 3 months following WBRT (in person and over the phone). The primary outcome was feasibility and inter-procedural (in person versus telephone) reliability. The secondary objective was to evaluate the change in neurocognitive function before and after WBRT. Results: Out of 39 patients enrolled, 82% of patients completed the baseline in-person and telephone neurocognitive assessments. However, at 1 month, only 41% of enrolled patients completed the in-person and telephone cognitive assessments and at 3 months, only 10% of patients completed them. Results pertaining to reliability and change in neurocognitive function will be updated. Conclusion: The pre-defined definition of feasibility (at least 80% completion for face to face and telephone neurocognitive assessments) was met at baseline. However, a large proportion of participants did not complete either telephone or in person neurocognitive follow-up at 1 month and at 3 months post-WBRT. Attrition remained a challenge for neurocognitive testing in this population even when a telephone-based brief assessment was used.

Introduction: The older adult population is growing. The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a MT-HI on the functional and cognitive outcomes six months post injury of older adults who sustained a minor trauma. Methods: This multicenter prospective cohort study in eight sites included patients who were: aged 65 years or older, presenting to the emergency department (ED) within two weeks of injury with a chief complaint of a minor trauma, discharged within 48 hours, and independent for their basic activities of daily living prior to the ED visit. Participants underwent a baseline evaluation and a follow-up evaluation at six months post-injury. The main outcome was the functional decline measured with the Older Americans’ Resources and Services (OARS) scale six months after the trauma. Results: All 926 eligible patients were included in the analyses: 344 MT-HI patients and 582 without head injury. After six months, the functional decline was similar in both groups, 10.8% and 11.9% respectively (RR=0.79 [95% CI: 0.55-1.14]). The proportion of participants with mild cognitive disabilities was also similar, 21.7% and 22.8% respectively (RR=0.91 [95% CI: 0.71-1.18]). Furthermore, for the group of patients with a MT-HI, the functional outcome was not statistically different with or without the presence of a co-injury (RR= 1.35 [95% CI: 0.71-2.59]), or with or without the presence of a mTBI as defined by the WHO criteria (RR= 0.90 [95% CI: 0.59-1.13]). Conclusion: This study did not demonstrate that the occurrence of a MT-HI is associated with a worse functional or cognitive prognosis than other minor injuries without a head injury in an elderly population six months after injury.

Multiple salmonellosis outbreaks have been linked to contaminated tomatoes. We investigated a multistate outbreak of Salmonella Typhimurium infections among 190 cases. For hypothesis generation, review of patients' food histories from four restaurant-associated clusters in four states revealed that large tomatoes were the only common food consumed by patients. Two case-control studies were conducted to identify food exposures associated with infections. In a study conducted in nine states illness was significantly associated with eating raw, large, round tomatoes in a restaurant [matched odds ratio (mOR) 3·1, 95% confidence interval (CI) 1·3–7·3]. In a Minnesota study, illness was associated with tomatoes eaten at a restaurant (OR 6·3, mid-P 95% CI 1·05–50·4, P=0·046). State, local and federal regulatory officials traced the source of tomatoes to Ohio tomato fields, a growing area not previously identified in past tomato-associated outbreaks. Because tomatoes are commonly eaten raw, prevention of tomato contamination should include interventions on the farm, during packing, and at restaurants.

Investigations of nematode hatching have concentrated on the parasitic forms, especially on synchronization between host and parasite life-cycles which, in some species, is so close that the parasite is dependent on the host for the hatching stimulus. Research into nematode hatching reflects the artificial separations created throughout nematology by defining research groups and their activities in terms of the host; consequently, useful comparisons between hatching of plant and animal parasitic nematodes have been few. With the increasing use by geneticists of nematodes as model animals and the interest in them by neuro-physiologists, molecular biologists and others, we hope that such distinctions will be lessened.

The authors have reviewed over 60 texts on the subject of Enterprise Risk Management (ERM). In this paper they set out a summary of ERM based on three of those sources, selected for their relevance and breadth of view. The paper observes that the approaches described vary widely in nature. A separate ‘on-line” source is provided, which summarises key readings from the 60 texts. Combining findings from these texts with the authors' own experiences, the paper suggests some best practice checklists, designed to enable organisations to take stock of their current ERM frameworks. It discusses other aspects of ERM for practitioners, including extreme events, opportunity management and the link with corporate strategy. The paper looks at immediate and longer-term implications for actuaries in the United Kingdom, and then poses questions about future professional development and education. It suggests an emerging role for the ‘ERM actuary’, and, finally, it suggests future work to progress the development of ERM and the actuaries' role.

The response of individual adult males of the potato cyst nematodes, Globodera rostochiensis and G. pallida, to sex pheromones from adult females was investigated using electrophysiological techniques. Each male nematode was pierced with an electrode close to the cephalic region and then exposed to pheromones from virgin females. Cellular responses in the form of action potentials were recorded as spike activity. The spike frequency produced by G. rostochiensis and G. pallida males increased significantly after the application of their homospecific pheromone. The spike frequency produced by G. pallida males also increased significantly after the application of G. rostochiensis female sex pheromone. In contrast, males of G. rostochiensis showed no significant response to G. pallida female sex pheromone. The electrophysiological results support and considerably extend information from agar plate behavioural bioassays.