Posts

01/28/2025


Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area. To help address this gap, we present evidence that highlights the pivotal role of evidence-based architectural design in service users' experience of mental health services. We propose six important design principles to enhance the care of mental health service users. Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, we outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience. In this Personal View, we argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels. BACKGROUND Childhood suicidal ideation and behaviours are poorly understood. We examined correlates of suicidality in a US population-based sample of children participating in the Adolescent Brain and Cognitive Development (ABCD) study. The ABCD study aims to examine trajectories of mental health from childhood to adulthood and collects information on multiple domains, including mental and physical wellbeing, brain imaging, behavioural and cognitive characteristics, and social and family environment. We sought to identify and rank risk and protective factors for childhood suicidal thoughts and behaviours across these multiple domains and evaluate their association with self-agreement and caregiver agreement in reporting suicidality. METHODS The ABCD sample comprises a cohort of 11 875 children aged 9-10 years. The sociodemographic factors on which the sample was recruited were age, sex, race, socioeconomic status, and urbanicity. Participants were enrolled at 22 sites, the catchment area of which encompassed rsely associated with the number of household cohabitants (0·8, 0·7-1·0). INTERPRETATION We identified risk and protective factors that show robust and generalisable associations with childhood suicidality. https://www.selleckchem.com/products/ABT-737.html These factors provide actionable targets for optimising prevention and intervention strategies, support the need to identify and treat psychopathology in school-age children, and underscore the importance of school and family interventions for childhood suicidality. FUNDING National Institutes of Health. BACKGROUND With increasingly precise radiotherapy and advanced medical imaging, the concept of radiotherapy target volume planning might be redefined with the aim of improving outcomes. We aimed to investigate whether target volume reduction is feasible and effective compared with conventional planning in the context of radical chemoradiotherapy for patients with locally advanced non-small-cell lung cancer. METHODS We did a multicentre, open-label, randomised, controlled trial (PET-Plan; ARO-2009-09) in 24 centres in Austria, Germany, and Switzerland. Previously untreated patients (aged older than 18 years) with inoperable locally advanced non-small-cell lung cancer suitable for chemoradiotherapy and an Eastern Cooperative Oncology Group performance status of less than 3 were included. Undergoing 18F-fluorodeoxyglucose (18F-FDG) PET and CT for treatment planning, patients were randomly assigned (11) using a random number generator and block sizes between four and six to target volume delineation informed by 1 [10%]). 20 deaths potentially related to study treatment were reported (seven vs 13). INTERPRETATION 18F-FDG PET-based planning could potentially improve local control and does not seem to increase toxicity in patients with chemoradiotherapy-treated locally advanced non-small-cell lung cancer. Imaging-based target volume reduction in this setting is, therefore, feasible, and could potentially be considered standard of care. The procedures established might also support imaging-based target volume reduction concepts for other tumours. FUNDING German Cancer Aid (Deutsche Krebshilfe). BACKGROUND CLEOPATRA was a phase 3 study comparing the efficacy and safety of pertuzumab, trastuzumab, and docetaxel with placebo, trastuzumab, and docetaxel in patients with HER2-positive metastatic breast cancer. In the primary analysis and subsequent reports, progression-free and overall survival were significantly improved in the pertuzumab group compared with the placebo group. Here, we report the end-of-study analysis of CLEOPATRA. METHODS This was a double-blind, randomised, placebo-controlled, phase 3 trial that was done at 204 centres in 25 countries. Eligible patients were 18 years or older, had HER2-positive, metastatic breast cancer, had not received previous chemotherapy or biological treatment for their metastatic disease, and had an Eastern Cooperative Oncology Group performance status of 0 or 1. All study drugs were given intravenously, every 3 weeks. Patients were assigned to receive either pertuzumab or placebo at a loading dose of 840 mg, and 420 mg thereafter; plus trastuzumab at 8 mg/kg lHER2-positive metastatic breast cancer, with the dual blockade of pertuzumab and trastuzumab, with docetaxel, demonstrating an 8-year landmark overall survival rate of 37%. FUNDING F Hoffmann-La Roche and Genentech. BACKGROUND Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS We did an open-label, non-inferiority, randomised (11 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter.

01/26/2025

Nhà cái RS8, hay còn gọi là RS8sport, đã chính thức ra mắt tại thị trường Việt Nam vào tháng 12 năm 2024. Ngay trong ngày đầu tiên hoạt động, nhà cái này đã thu hút hơn 10.000 người đăng ký, cho thấy sự hấp dẫn và tiềm năng phát triển của nền tảng này.
Địa chỉ: 222 Đ. Võ Chí Công, Phường Phú Hữu, Quận 9, Hồ Chí Minh , Việt Nam
Phone: 0910686868
Zipcode: 700000
Website: https://rs8.art/
Email: nhacairs8@gmail.com
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Nhà cái RS8 – Trang cá cược uy tín với kèo nhà cái, tỷ lệ cược hấp dẫn, khuyến mãi nạp tiền, hoàn trả cược, cá cược thể thao, casino trực tuyến, đá gà, nổ hũ, game bài.

rs8.art

12/15/2024

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Rs8 là địa điểm giải trí trực tuyến chất lượng và uy tín hàng đầu châu Á. Tham gia nhà cái ngay hôm nay để khám phá thế giới trò chơi đa dạng

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Posts

01/28/2025


Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area. To help address this gap, we present evidence that highlights the pivotal role of evidence-based architectural design in service users' experience of mental health services. We propose six important design principles to enhance the care of mental health service users. Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, we outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience. In this Personal View, we argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels. BACKGROUND Childhood suicidal ideation and behaviours are poorly understood. We examined correlates of suicidality in a US population-based sample of children participating in the Adolescent Brain and Cognitive Development (ABCD) study. The ABCD study aims to examine trajectories of mental health from childhood to adulthood and collects information on multiple domains, including mental and physical wellbeing, brain imaging, behavioural and cognitive characteristics, and social and family environment. We sought to identify and rank risk and protective factors for childhood suicidal thoughts and behaviours across these multiple domains and evaluate their association with self-agreement and caregiver agreement in reporting suicidality. METHODS The ABCD sample comprises a cohort of 11 875 children aged 9-10 years. The sociodemographic factors on which the sample was recruited were age, sex, race, socioeconomic status, and urbanicity. Participants were enrolled at 22 sites, the catchment area of which encompassed rsely associated with the number of household cohabitants (0·8, 0·7-1·0). INTERPRETATION We identified risk and protective factors that show robust and generalisable associations with childhood suicidality. https://www.selleckchem.com/products/ABT-737.html These factors provide actionable targets for optimising prevention and intervention strategies, support the need to identify and treat psychopathology in school-age children, and underscore the importance of school and family interventions for childhood suicidality. FUNDING National Institutes of Health. BACKGROUND With increasingly precise radiotherapy and advanced medical imaging, the concept of radiotherapy target volume planning might be redefined with the aim of improving outcomes. We aimed to investigate whether target volume reduction is feasible and effective compared with conventional planning in the context of radical chemoradiotherapy for patients with locally advanced non-small-cell lung cancer. METHODS We did a multicentre, open-label, randomised, controlled trial (PET-Plan; ARO-2009-09) in 24 centres in Austria, Germany, and Switzerland. Previously untreated patients (aged older than 18 years) with inoperable locally advanced non-small-cell lung cancer suitable for chemoradiotherapy and an Eastern Cooperative Oncology Group performance status of less than 3 were included. Undergoing 18F-fluorodeoxyglucose (18F-FDG) PET and CT for treatment planning, patients were randomly assigned (11) using a random number generator and block sizes between four and six to target volume delineation informed by 1 [10%]). 20 deaths potentially related to study treatment were reported (seven vs 13). INTERPRETATION 18F-FDG PET-based planning could potentially improve local control and does not seem to increase toxicity in patients with chemoradiotherapy-treated locally advanced non-small-cell lung cancer. Imaging-based target volume reduction in this setting is, therefore, feasible, and could potentially be considered standard of care. The procedures established might also support imaging-based target volume reduction concepts for other tumours. FUNDING German Cancer Aid (Deutsche Krebshilfe). BACKGROUND CLEOPATRA was a phase 3 study comparing the efficacy and safety of pertuzumab, trastuzumab, and docetaxel with placebo, trastuzumab, and docetaxel in patients with HER2-positive metastatic breast cancer. In the primary analysis and subsequent reports, progression-free and overall survival were significantly improved in the pertuzumab group compared with the placebo group. Here, we report the end-of-study analysis of CLEOPATRA. METHODS This was a double-blind, randomised, placebo-controlled, phase 3 trial that was done at 204 centres in 25 countries. Eligible patients were 18 years or older, had HER2-positive, metastatic breast cancer, had not received previous chemotherapy or biological treatment for their metastatic disease, and had an Eastern Cooperative Oncology Group performance status of 0 or 1. All study drugs were given intravenously, every 3 weeks. Patients were assigned to receive either pertuzumab or placebo at a loading dose of 840 mg, and 420 mg thereafter; plus trastuzumab at 8 mg/kg lHER2-positive metastatic breast cancer, with the dual blockade of pertuzumab and trastuzumab, with docetaxel, demonstrating an 8-year landmark overall survival rate of 37%. FUNDING F Hoffmann-La Roche and Genentech. BACKGROUND Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS We did an open-label, non-inferiority, randomised (11 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter.

01/26/2025

Nhà cái RS8, hay còn gọi là RS8sport, đã chính thức ra mắt tại thị trường Việt Nam vào tháng 12 năm 2024. Ngay trong ngày đầu tiên hoạt động, nhà cái này đã thu hút hơn 10.000 người đăng ký, cho thấy sự hấp dẫn và tiềm năng phát triển của nền tảng này.
Địa chỉ: 222 Đ. Võ Chí Công, Phường Phú Hữu, Quận 9, Hồ Chí Minh , Việt Nam
Phone: 0910686868
Zipcode: 700000
Website: https://rs8.art/
Email: nhacairs8@gmail.com
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12/15/2024

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10/22/2024


Angioleiomyoma of the pulmonary artery is rare in the literature and few studies have been reported. Here we present a rare case of angioleiomyoma arising from the pulmonary artery in a young patient.

A 27-year-old male patient presented to our clinic due to the incidental finding of a nodule in the right lower lobe of the lung, which was unchanged from the prior year. Preoperative CT scans showed a well-demarcated nodule of soft tissue density penetrated by the basal branch of the right anterior basilar artery (RA8b). Single-port video-assisted RS8 segmentectomy was performed under the guidance of preoperative 3-dimensional reconstruction for histologic confirmation of the tumour. The tumour appeared as a solid tumour of a tube-like structure with vascular endothelium, composed of spindle-shaped smooth muscle cells lacking nuclear atypia and homogenous red-dye substances. The spindle cells were positive for immunostaining for smooth muscle actin (SMA), desmin and Ki-67 and were negative for immunostaining for Dog-1, HMB45, and Melan-A. A pathological diagnosis of primary angioleiomyoma of the pulmonary artery was finally made.

This report is a reminder for thoracic surgeons that angioleiomyoma should be included in the differential diagnosis of lung neoplasms, especially for the mass of soft tissue density penetrated by pulmonary blood vessels shown by CT. Awareness of this rare entity should potentially prevent underdiagnosis and improper surgical treatment.
This report is a reminder for thoracic surgeons that angioleiomyoma should be included in the differential diagnosis of lung neoplasms, especially for the mass of soft tissue density penetrated by pulmonary blood vessels shown by CT. Awareness of this rare entity should potentially prevent underdiagnosis and improper surgical treatment.A number of novel anticancer drugs have been developed in recent years. https://www.selleckchem.com/products/ABT-869.html However, the mortality of cancer patients remains high because of the emergence of drug resistance. It was reported that drug resistance might involved in changes in gene expression without changing genotypes, which is similar to epigenetic modification. Some studies indicated that targeting histone methyltransferase can reverse drug resistance. Hence, the use of histone methyltransferase inhibitors or histone demethylase inhibitors opens new therapeutic approaches for cancer treatment. While the relationship between histone methyltransferase and tumor resistance has been determined, there is a lack of updated review on the association between them. In this review, we summarized the mechanisms of histone methyltransferases in cancer drug resistance and the therapeutic strategies of targeting histone methyltransferase to reverse drug resistance.
Given the difficulty in preoperatively diagnosing lymph node metastasis, patients with Stage I-III non-small cell lung cancer (NSCLC) are likely to be included in the clinical N1 (cN1) group. However, better treatment options might be selected through further stratification. This study aimed to identify preoperative clinicopathological prognostic and stratification factors for patients with cN1 NSCLC.

This retrospective study evaluated 60 patients who were diagnosed with NSCLC during 2004-2014. Clinical nodal status had been evaluated using routine chest computed tomography (CT) and/or positron emission tomography (PET). To avoid biasing the fluorodeoxyglucose uptake values based on inter-institution or inter-model differences, we used only two PET systems (one PET system and one PET/CT system). Relapse-free survival (RFS) and overall survival (OS) were the primary study outcomes. The maximum standardized uptake value (SUVmax) was calculated for each tumor and categorized as low or high based on the mediahe primary tumor's SUVmax value, minimizing bias between facilities and models could lead to a more accurate prognostication.
For patients with cN1 NSCLC, preoperative prognosis and stratification might be performed based on CEA expression, age, and the primary tumor's SUVmax value. To enhance the prognostic value of the primary tumor's SUVmax value, minimizing bias between facilities and models could lead to a more accurate prognostication.
Thrombotic thrombocytopenic purpura (TTP) is associated with more deleterious outcomes in patients with systemic lupus erythematosus (SLE). However, ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) levels and ADAMTS13 inhibitor were not routinely assayed in most previous studies. The objective of this study is to compare the characteristics and outcomes of immune-mediated TTP (iTTP) in patients with and without SLE.

The medical data of 28 patients with iTTP from Peking Union Medical College Hospital were analysed. ADAMTS13 activity and ADAMTS13 inhibitor were measured in all patients.

All 28 patients had ADAMTS13 inhibitor and severe ADAMTS13 deficiency. iTTP was considered SLE-related (SLE-TTP) in 10 patients and primary (primary iTTP) in 18 patients. Renal involvement on presentation was more severe in patients with primary iTTP as determined by higher serum creatinine (162.7 ± 110.6 vs 73.3 ± 13.4 μmol/L, p < 0.01) and more prevalent acute kidney injury than in patients with primary iTTP. The treatment responses and outcomes of SLE-TTP were no worse and perhaps even better than those of primary iTTP. When TTP is diagnosed in SLE patients, the ADAMTS13 level and ADAMTS13 inhibitor profile should be considered in addition to clinical features.
Mast cells play an important role in early immune reactions in the brain by degranulation and the consequent inflammatory response. Our aim of the study is to investigate the effects of rh-relaxin-2 on mast cells and the underlying mechanisms in a germinal matrix hemorrhage (GMH) rat model.

One hundred seventy-three P7 rat pups were subjected to GMH by an intraparenchymal injection of bacterial collagenase. Clodronate liposome was administered through intracerebroventricular (i.c.v.) injections 24 h prior to GMH to inhibit microglia. Rh-relaxin-2 was administered intraperitoneally at 1 h and 13 h after GMH. Small interfering RNA of RXFP1 and PI3K inhibitor LY294002 were given by i.c.v. injection. Post-GMH evaluation included neurobehavioral function, Western blot analysis, immunofluorescence, Nissl staining, and toluidine blue staining.

Our results demonstrated that endogenous relaxin-2 was downregulated and that RXFP1 level peaked on the first day after GMH. Administration of rh-relaxin-2 improved neurological functions, attenuated degranulation of mast cells and neuroinflammation, and ameliorated post-hemorrhagic hydrocephalus (PHH) after GMH.

10/03/2024


ove local control and does not seem to increase toxicity in patients with chemoradiotherapy-treated locally advanced non-small-cell lung cancer. Imaging-based target volume reduction in this setting is, therefore, feasible, and could potentially be considered standard of care. The procedures established might also support imaging-based target volume reduction concepts for other tumours. FUNDING German Cancer Aid (Deutsche Krebshilfe). BACKGROUND CLEOPATRA was a phase 3 study comparing the efficacy and safety of pertuzumab, trastuzumab, and docetaxel with placebo, trastuzumab, and docetaxel in patients with HER2-positive metastatic breast cancer. In the primary analysis and subsequent reports, progression-free and overall survival were significantly improved in the pertuzumab group compared with the placebo group. Here, we report the end-of-study analysis of CLEOPATRA. METHODS This was a double-blind, randomised, placebo-controlled, phase 3 trial that was done at 204 centres in 25 countries. Eligible patients were 18 years or older, had HER2-positive, metastatic breast cancer, had not received previous chemotherapy or biological treatment for their metastatic disease, and had an Eastern Cooperative Oncology Group performance status of 0 or 1. All study drugs were given intravenously, every 3 weeks. Patients were assigned to receive either pertuzumab or placebo at a loading dose of 840 mg, and 420 mg thereafter; plus trastuzumab at 8 mg/kg lHER2-positive metastatic breast cancer, with the dual blockade of pertuzumab and trastuzumab, with docetaxel, demonstrating an 8-year landmark overall survival rate of 37%. FUNDING F Hoffmann-La Roche and Genentech. BACKGROUND Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS We did an open-label, non-inferiority, randomised (11 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had tonal, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac. © 2020 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.Genomics is a sequence-based informatics science and a three-dimensional-structure-based material science. However, in practice, most genomics researchers utilize sequence-based informatics approaches or three-dimensional-structure-based material science techniques, not both. This division is, at least in part, the result of historical developments rather than a fundamental necessity. The underlying computational tools, experimental techniques, and theoretical models were developed independently. The primary result presented here is a framework for the unification of informatics- and physics-based data associated with DNA, nucleosomes, and chromatin. The framework is based on the mathematical representation of geometrically exact rods and the generalization of DNA basepair step parameters. Data unification enables researchers to integrate computational, experimental, and theoretical approaches for the study of chromatin biology. The framework can be implemented using model-view-controller design principles, existing genome browsers, and existing molecular visualization tools. We developed a minimal, web-based genome dashboard, G-Dash-min, and applied it to two simple examples to demonstrate the usefulness of data unification and proof of concept. Genome dashboards developed using the framework and design principles presented here are extensible and customizable and are therefore more broadly applicable than the examples presented. We expect a number of purpose-specific genome dashboards to emerge as a novel means of investigating structure-function relationships for genomes that range from basepairs to entire chromosomes and for generating, validating, and testing mechanistic hypotheses. Here, we discuss options to reform the EU genetically modified organism (GMO) regulatory framework, to make risk assessment and decision-making more consistent with scientific principles, and to lay the groundwork for international coherence. We discussed the scope and definitions in a previous article and, thus, here we focus on the procedures for risk assessment and risk management. Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed. To take the best actions, we often need to maintain and update beliefs about variables that cannot be directly observed. To understand the principles underlying such belief updates, we need tools to uncover subjects' belief dynamics from natural behavior. We tested whether eye movements could be used to infer subjects' beliefs about latent variables using a naturalistic navigation task. Humans and monkeys navigated to a remembered goal location in a virtual environment that provided optic flow but lacked explicit position cues. We observed eye movements that appeared to continuously track the goal location even when no visible target was present there. Accurate goal tracking was associated with improved task performance, and inhibiting eye movements in humans impaired navigation precision. These results suggest that gaze dynamics play a key role in action selection during challenging visuomotor behaviors and may possibly serve as a window into the subject's dynamically evolving internal beliefs. Debate is ongoing regarding when, why, and how to initiate pharmacotherapy for Parkinson's disease. Early initiation of dopaminergic therapies does not convey disease-modifying effects but does reduce disability. Concerns about the development of motor complications arising from the early initiation of levodopa, which led to misconceived levodopa-sparing strategies, have been largely mitigated by the outcomes of the PD MED and Levodopa in Early Parkinson's Disease (LEAP) studies. The LEAP study also showed the potential for early improvement in quality of life, even when disability is negligible. Until more effective methods of providing stable dopamine concentrations are developed, current evidence supports the use of levodopa as initial symptomatic treatment in most patients with Parkinson's disease, starting with low doses and titrating to therapeutic threshold. Monoamine oxidase-B inhibitors and dopamine agonists can be reserved as potential adjunct treatments later in the disease course. Future research will need to establish effective disease-modifying treatments, address whether patients' quality of life is substantially improved with early initiation of treatment rather than a wait and watch strategy, and establish whether new levodopa formulations will delay onset of dyskinesia. Complex regional pain syndrome (CRPS) is a relatively common condition that is often not well recognised or treated adequately. Patients are usually referred to multidisciplinary pain services, but outcomes remain variable. https://www.selleckchem.com/products/aprotinin.html This case report describes a recent patient with CRPS who was treated quickly and effectively through a simple explanation of the relationship between mind and body, and who then was able to modify her own thought processes and behaviours. This single intervention enabled a complete resolution of symptoms. This report illustrates the clinical application of recent insights into neuroplasticity and individually tailored patient self-management that may now offer successful treatment of an otherwise chronic and disabling condition, especially in younger patients. There are implications for doctors in current practice, as well as for the training of medical students and junior doctors.INTRODUCTION Childhood obesity is a major health concern in New Zealand. Primary care nurses have been charged with body mass index (BMI) screening and initiating education or referral of 4-year-old children during the Before School Check (B4SC). Asking nurses about their BMI screening experiences when reporting is mandated by the Ministry of Health reveals valuable knowledge to inform the work of health professionals in this area. AIM To explore the experience of nurses performing the B4SC since the inclusion of the Raising Healthy Kids targets into the wellchild check. METHODS Five focus group discussions across New Zealand were conducted using the Nominal Group Technique. Nurses individually recorded their answers to the research question, 'What is your perception of performing the B4SC since the inclusion of the Raising Healthy Kids target in July 2016?'. Group discussion and establishing priorities followed. Researchers collated and analysed data. Results were obtained by adding up scores across groups to provide the final overall themes of (i) communication; (ii) BMI as a measurement; (iii) cultural norms and socioeconomic situations; (iv) parenting and family structure; and (v) education. RESULTS Communication was the common theme across groups, but other priorities were more specific to the sociodemographic and cultural profile of the areas of practice. Mandatory reporting appears to have had the positive outcome of encouraging nurses to use positive and holistic discussion on health to families rather than concentrating on BMI. Nurses reported using tools to educate parents without implying judgement of their parenting and lifestyle. DISCUSSION Nurses worked hard to maintain relationships with families as they recognised the long-term value of keeping families engaged with health professionals. Where tools were useful, such as the BMI calculator, nurses used these to assist with positive communication. The mandatory nature of the BMI referral had enhanced their skills with difficult conversations.