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Background This study aimed to investigate the validity of the Active Australia Survey across different subgroups and its responsiveness to change, as few previous studies have examined this. Methods The Active Australia Survey was validated against the ActiGraph as an objective measure of physical activity. Participants ( n  = 465) wore the ActiGraph for 7 days and subsequently completed the Active Australia Survey. Moderate activity, vigorous activity and total moderate and vigorous physical activity were compared using Spearman rank-order correlations. Changes in physical activity between baseline and 3-month assessments were correlated to examine responsiveness to change. The data were stratified to assess outcomes according to different subgroups (e.g., gender, age, weight, activity levels). Results With regards to the validity, a significant correlation of ρ = 0.19 was found for moderate physical activity, ρ = 0.33 for vigorous physical activity and ρ = 0.23 for moderate and vigorous physical activity combined. For vigorous physical activity correlations were higher than 0.3 for most subgroups, whereas they were only higher than 0.3 in those with a healthy weight for the other activity outcomes. With regards to responsiveness to change, a correlation of ρ = 0.32 was found for moderate physical activity, ρ = 0.19 for vigorous physical activity and ρ = 0.35 for moderate and vigorous physical activity combined. For moderate and vigorous activity combined correlations were higher than 0.4 for several subgroups, but never for vigorous physical activity. Conclusions Little evidence for the validity of Active Australia Survey was found, although the responsiveness to change was acceptable for several subgroups. Findings from studies using the Active Australia Survey should be interpreted with caution. Trial registration World Health Organisation Universal Trial Number: U111–1119-1755. Australian New Zealand Clinical Trials Registry, ACTRN12611000157976 . Registration date: 8 March 2011.

Resistance training research highlights the importance of training intensity to resistance exercise training (RET) and the associated benefits to health and function for healthy and at-risk populations. The American College of Sports Medicine (ACSM) recommend specific intensities, frequencies, repetitions, and number of exercises of RET to be performed to maintain health. The primary aim of this study was to describe the prevalence of achieving recommended levels of RET in relation to ACSM guidelines for intensity, frequency, repetitions, and number of exercises in a regional Australian population. A Computer-Assisted-Telephone-Interview (CATI) survey (n=1237) was conducted to determine RET participation. Participants were 18 years plus, residing in Central Queensland, Australia. The prevalence of respondents performing ‘No RET’, ‘insufficient RET’ and ‘sufficient RET’ were 79.6.0%, 15.2% and 5.2% respectively. Significantly higher proportions of younger adults adhered to all RET guidelines for intensity (19.2 vs 8.1%), frequency (19.9 vs 11.6%), repetitions (17.8 vs 6.3%), and number of exercises (8.2 vs 3.6%) (p<0.05). Significantly higher proportions of males, younger adults (18–34 years), higher educated individuals (>15 years), and individuals engaging in sufficient levels of aerobic exercise training (AET) engaged in sufficient levels of RET (p<0.05). The prevalence of Australian’s participating in regular RET programs is low and only a small proportion of participants meet ACSM guidelines for the quantity and quality of RET that is likely to provide health benefits. This has implications for public health policy and the future development and promotion of population-level RET guidelines.

Increasingly, we are electronically \"shadowed\" online, our actions and behaviors observed and analyzed so we can be \"microtargeted.\" Companies use powerful techniques, including behavioral targeting, neuro-marketing and social media tracking, to sell and promote in the digital era. Of particular concern is how interactive marketing collects data about our health and financial concerns, as well as from children and teens.

The light at the end of the tunnel is the increase in the number of insert media programs in the package insert category, primarily from online companies. One recent example is Shutterfly, which sends more than 6 million packages of onlinepurchased photo prints per year. With an increase in the number of insert programs, there will continue to be price sensitivity, which is advantageous to the mailers using the medium.

Correspondence to Dr Mark E Roberts, Department Of Respiratory Medicine, King's Mill Hospital, Sutton-in-Ashfield, NG174JL, UK; mark.roberts@nhs.net Summary of recommendations and good practice points Spontaneous pneumothorax Acute management for spontaneous pneumothorax Recommendations Conservative management can be considered for the treatment of minimally symptomatic (ie, no significant pain or breathlessness and no physiological compromise) or asymptomatic primary spontaneous pneumothorax in adults regardless of size. Optimal management after the resolution of a first episode of pneumothorax Good practice points Elective surgery may be considered for patients in whom recurrence prevention is deemed important (eg, at-risk professionals (divers, airline pilots, military personnel), or those who developed a tension pneumothorax at first episode). In patients with an undiagnosed pleural effusion where pleural infection is possible and volume of fluid sample available allows, microbiological samples should be sent in both white top containers and volumes of 5–10 mL inoculated into (aerobic and anaerobic) blood culture bottles. (Conditional) Good practice points The clinical utility of pleural fluid cytology varies by tumour subtype, including diagnostic sensitivity and predictive value for response to subsequent cancer therapies.

Pleural disease is common and represents a major and rapidly developing subspecialty that presents to many different hospital services. Since the last BTS Guideline for pleural disease published in 2010,3–9 many high quality and practice changing studies, using patient centred outcomes, have been published. Target audience for the guideline The guideline will be of interest to UK based clinicians caring for adults with pleural disease, including chest physicians, respiratory trainees, specialist respiratory nurses, specialist lung cancer nurses, specialist pleural disease nurses, pathologists, thoracic surgeons, thoracic surgeon trainees, acute physicians, oncologists, emergency physicians, hospital practitioners, intensive care physicians, palliative care physicians, radiologists, other allied health professional and patients and carers. Following data extraction from the ‘accepted’ papers, evidence profiles were generated for each of the clinical questions and the quality of the evidence was assessed using the GRADE principles.12 Where GRADE analysis was not possible, but the evidence was deemed important enough to be included in the guideline, the evidence has been listed as (Ungraded), denoting that inclusion was reached by consensus of the guideline development group. Optimal management after the resolution of a first episode of pneumothorax Good practice points Elective surgery may be considered for patients in whom recurrence prevention is deemed important (eg, at risk professionals (divers, airline pilots, military personnel), or those who developed a tension pneumothorax at first episode).

Primary spontaneous pneumothorax occurs in otherwise healthy young patients. Optimal management is not defined and often results in prolonged hospitalisation. Data on efficacy of ambulatory options are poor. We aimed to describe the duration of hospitalisation and safety of ambulatory management compared with standard care. In this open-label, randomised controlled trial, adults (aged 16–55 years) with symptomatic primary spontaneous pneumothorax were recruited from 24 UK hospitals during a period of 3 years. Patients were randomly assigned (1:1) to treatment with either an ambulatory device or standard guideline-based management (aspiration, standard chest tube insertion, or both). The primary outcome was total length of hospital stay including re-admission up to 30 days after randomisation. Patients with available data were included in the primary analysis and all assigned patients were included in the safety analysis. The trial was prospectively registered with the International Standard Randomised Clinical Trials Number, ISRCTN79151659. Of 776 patients screened between July, 2015, and March, 2019, 236 (30%) were randomly assigned to ambulatory care (n=117) and standard care (n=119). At day 30, the median hospitalisation was significantly shorter in the 114 patients with available data who received ambulatory treatment (0 days [IQR 0–3]) than in the 113 with available data who received standard care (4 days [IQR 0–8]; p<0·0001; median difference 2 days [95% CI 1–3]). 110 (47%) of 236 patients had adverse events, including 64 (55%) of 117 patients in the ambulatory care arm and 46 (39%) of 119 in the standard care arm. All 14 serious adverse events occurred in patients who received ambulatory care, eight (57%) of which were related to the intervention, including an enlarging pneumothorax, asymptomatic pulmonary oedema, and the device malfunctioning, leaking, or dislodging. Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention. UK National Institute for Health Research.

This paper reports the findings from a study of 935 adolescents' perceived attachments to their parents and peers, and their psychological health and well-being. Perceived attachment to parents did not significantly differ between males and females. However, females scored significantly higher than males on a measure of attachment to peers. Also, relative to males, they had higher anxiety and depression scores, suggesting poorer psychological well-being. Overall, a lower perceived attachment to parents was significantly associated with lower scores on the measures of well-being. Adolescents who perceived high attachments to both their parents and peers had the highest scores on a measure of self-perceived strengths. In this study, adolescents' perceived attachment to peers did not appear to compensate for a low attachment to parents in regard to their mental ill-health. These findings suggest that high perceived attachment to parents may be a critical variable associated with psychological well-being in adolescence.