Review of the effectiveness of predictive models for mesothelioma to identify lessons for asbestos-related policy

Predictions of future cases of asbestos-related disease have been undertaken at a national level to inform government policy and planning for future health needs. In general, we can separate the methods used to predict future cases of mesothelioma into models that use a) direct or b) indirect estimates of asbestos exposure. Direct estimates are those that have been derived mostly for occupationally exposed cohorts, where airborne fibre levels were measured over time. Indirect estimates tend to be information about total or fibre-specific asbestos imports or use from a range of time points. Most predictions undertaken at the national level have predicted future cases for males only and assume that indirect estimates of asbestos consumption reflect occupational asbestos exposure. These models tend to fit the observed data reasonably well but have undergone several refinements in order to improve their fit. Fewer attempts have been made to predict cases of mesothelioma resulting from non-occupational asbestos exposure, and most have not subsequently revisited their prediction to ascertain its accuracy so the robustness of these methods is unclear. Because of the change in asbestos use in recent decades, more attention should be paid to understanding the risks and burden of future cases arising from non-occupational exposure. A range of current data exist that should be sufficient to incorporate into models to predict future cases of mesothelioma arising from non-occupational asbestos exposure. Models could be tested for their accuracy by comparing them against the most recent 10 years of observed cases or against cases in women, whose most common source of exposure is non-occupational

Approaches to the core structure of the squalestatins

The squalestatins are a new family of natural products which display potent cholesterol lowering effects. Common to all these natural products is the highly oxidised bicyclic core and the aim of this project was to achieve a concise synthetic route to this core unit. Initial studies were carried out using 2-benzyloxycyclohexanone as a model template. Following conversion to the 2-oxa-3-oxo-spirodecan-6-one via addition of the dianion of 3-(para- tolylsulphonyl)propionic acid, coupling of a C(2) fragment was explored. Addition of carboethoxymethylenetriphenylphosphorane, followed by oxidation to the diol and protection as the acetonide led to the formation of 4- Ethoxycarbonyl-(2,2-dimethyl-5"-oxodispiro[perhydro[l,3]dioxolane-4,r- cyclohexane-2',2"-(5"-H-furan)]-5-yl. The alternative order of addition of the C(4) and C(2) units has also been undertaken. Manipulation of the ester group to a silyl ether afforded a less reactive functionality and C(4) was manipulated to allow for the coupling of the next fragment to form the spiro lactone. The addition of the dianion of 3-(parc-tolylsulphonyl)propionic acid to4-((^t)butyldimethylsilyloxymethyl)-2,2-dimethyl-l,3-dioxa-spirodecan-6-one failed and another route to the spiro lactone was explored. Formation of 4 - ((^t)butyldimethy Isilyloxymethy l)-2,2-dimethyl-1,3,7-trioxa- dispirotetradecan-8-one (I) was achieved by allylation at C(4) followed by hydroboration of the double bond and subsequent oxidation. The C(l) side chain could be added to the spiro lactone using allyl magnesium bromide without compromising the other functionality present. Acid treatment of 4-((^t)butyldimethylsilyloxymethyl)-8-methoxy-2,2-dimethyl-8- propyl-l,3,7-trioxa-dispirotetradecane (II) promoted deprotection of the acetonide followed by concomitant cyclisation to the desired 6-hydroxy-9-propyl- 8,12-dioxatricyclododec-7-yl-l-methanol (III). This showed the viability of the retrosynthetic analysis as a route to core analogues of the squalestatins. Studies to the fully substituted core were commenced using cis-cyclohexadiene diol. The diol was protected as its p-anisaldehyde acetal before the formation of the Diels Alder adduct (IV) using 4-phenyl-l,3,5-triazolinone. However a lack of time prevented its manipulation to the a-alkoxy ketone species through Lewis Acid mediated cleavage of the acetal. In a second retrosynthetic plan 2-benzyloxycyclohexanone was coupled with methyl tetronate prepared following the procedure of Pelter. Preliminary studies towards the addition of the C(l) side chain have been undertaken and initial results seem promisin

Examining the Impact of Two Dimensions of Precarious Employment, Vulnerability and Insecurity on the Self-Reported Health of Men, Women and Migrants in Australia

Precarious employment is increasing and adversely affects health. We aimed to investigate how perception of precariousness in current employment impacts gender and migrant workers in Australia. Using cross-sectional interviews of 1292 workers born in Australia, New Zealand, India and the Philippines, data were collected on self-reported health, employment conditions and sociodemographics. Factor analysis of nine questions about perceptions of current employment revealed two dimensions, vulnerability and insecurity. Women had higher vulnerability scores (µ = 6.5 vs. µ = 5.5, t = 5.40, p-value (p) < 0.000) but lower insecurity scores (µ = 8.6 vs. µ = 9.3 t = −4.160 p < 0.0003) than men. Filipino-born workers had higher vulnerability compared with other migrant workers (µ = 6.5 vs. µ = 5.8 t = −3.47 p < 0.0003), and workers born in India had higher insecurity compared with other migrant workers (µ = 9.8 vs. µ = 8.9, t = −6.1 p < 0.0001). While the prevalence of insecurity varied by migrant status, the negative effect on health was higher for Australian-born workers than migrants. Increasing levels of vulnerability and insecurity impacted self-reported health negatively (Coefficient (Coef).0.34 p < 0.0001; Coef.0.25 p < 0.0001, respectively). The combination of high vulnerability and high insecurity had the greatest impact on health (Coef. 2.37 p = 0.002), followed by high vulnerability and moderate insecurity (Coef. 2.0 p = 0.007). Our study suggests that understanding both changes in employment conditions over time as well as knowledge of cultural patterns may offer the best chance of understanding the impact of precarious employment experiences.This research was funded by the Australian Research Council Discovery Project, grant number DP160100660

Calcium supplements with or without vitamin D and risk of cardiovascular events : reanalysis of the Women's Health Initiative limited access dataset and meta-analysis

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Seasonal Variation in 25(OH)D at Aberdeen (57°N) and Bone Health Indicators- Could Holidays in the Sun and Cod Liver Oil Supplements Alleviate Deficiency?

Vitamin D has been linked with many health outcomes. The aim of this longitudinal study, was to assess predictors of seasonal variation of 25-hydroxy-vitamin D (25(OH)D) (including use of supplements and holidays in sunny destinations) at a northerly latitude in the UK (57°N) in relation to bone health indicators. 365 healthy postmenopausal women (mean age 62.0 y (SD 1.4)) had 25(OH)D measurements by immunoassay, serum C-telopeptide (CTX), estimates of sunlight exposure (badges of polysulphone film), information regarding holidays in sunny destinations, and diet (from food diaries, including use of supplements such as cod liver oil (CLO)) at fixed 3-monthly intervals over 15 months (subject retention 88%) with an additional 25(OH)D assessment in spring 2008. Bone mineral density (BMD) at the lumbar spine (LS) and dual hip was measured in autumn 2006 and spring 2007 (Lunar I-DXA). Deficiency prevalence (25(OH)

‘Teleswallowing’: a case study of remote swallowing assessment

Purpose: Telemedicine has enabled speech and language therapists (SLTs) to remotely assess swallowing difficulties (dysphagia) experienced by nursing home residents. The new technique, “teleswallowing”, was designed by the Speech and Language Therapy Service at Blackpool Teaching Hospitals NHS Foundation Trust. It allows prompt assessment, avoiding potential risks of aspiration pneumonia, malnutrition, poor rehabilitation, increased hospital stays and reduced quality of life (Hinchey et al., 2005; Langmore et al., 1998). The purpose of this paper is to report on a second pilot of teleswallowing and the concomitant adoption study. Design/methodology/approach: The adoption study employed qualitative methods, including consultations with senior managers, semi-structured interviews with nursing home matrons/managers and nurses, two focus groups and semi-structured interviews with SLTs. The project clinical lead kept an activity log, which was used to estimate resource savings. Findings: Over a three-month period, six SLTs and 17 patients in five nursing homes participated in teleswallowing assessments. Teleswallowing benefited both patients and participating nursing homes. Better use of therapist time and cost savings were demonstrated and evidence showed that the service could be successfully scaled up. Despite this, a number of barriers to service transformation were identified. Originality/value: This is the first implementation of teleswallowing in the UK, but it has been used in Australia (Ward et al., 2012). The approach to engaging stakeholders to understand and address barriers to adoption is novel. The value lies in the lessons learned for future innovations

Do Demographic Profiles of Listed and Unlisted Households Differ? Results of a Nationwide Telephone Survey

A growing number of households are not reachable through traditional directory-based samples, which can have important implications for the representativeness of telephone surveys. The current study aims to investigate the demographic differences between households which have their telephone numbers listed or not listed in the Australian White Pages telephone directory. A total of 5,023 eligible Australian residents who were currently in paid employment participated in this study. Each respondent’s telephone number was individually matched to the residential White Pages to determine its listed status, and demographic variables were compared between those with a listed and unlisted telephone number. Those with an unlisted number were significantly more likely to be younger, to have been born in a country outside of Australia, and to live in a lower socioeconomic area than those who were listed in the White Pages. These demographic differences should be considered when undertaking telephone surveys using a White Pages sample

Calcium supplements and cancer risk : a meta-analysis of randomised controlled trials

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Effect of calcium supplements on risk of myocardial infarction and cardiovascular events : meta-analysis

Peer reviewedPublisher PD