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42, 95% CI; 0.17-0.92). No differences were found in gestational age at onset of spontaneous labor, duration of the active phase of labor, interval between induction and the active phase of labor, cesarean section rates, birth weight, and Apgar scores. No maternal or fetal heart rate abnormalities were recorded during the exercise sessions.Conclusions For low-risk women at term walking for 30 min 3 times a week at 4 km/h from 38-week onwards is safe, enhances the spontaneous onset of labor and reduces operative vaginal delivery rates.Key Message Physical exercise at term is empirically used as a method of enhancing the spontaneous labor onset. In finding that for low-risk women walking for 30 min 3 times a week at 4 km/h from 38-week onwards enhances spontaneous labor onset of and reduces operative vaginal delivery.Clinical Trial Registration ClinicalTrials.gov. PF-02341066 chemical structure www.clinicaltrials.gov NCT02460185.Background Head and neck squamous cell carcinoma (HNSCC) is a significant global burden. The development of a diagnostic or recurrence monitoring test could evolve from the exploitation of molecular markers such as tumour-specific DNA alterations in plasma. The aim of this study was to report specific genetic alterations of DNA in plasma from HNSCC patients, report the diagnostic accuracy, and discuss potentials for a diagnostic or recurrence monitoring test based on circulating tumour DNA (ctDNA).Methods A systematic search was performed in PubMed, Embase, and Cochrane Library for articles published in English between 1 January 1980 and 24 October 2018. The search terms used were related to ctDNA methylations and mutations in HNSCC patients.Results We identified 16 studies from four countries (p = 1156 patients, c = 601 controls) examining ctDNA alterations of HNSCC patients. CtDNA methylations were significantly increased in HNSCC patients compared to controls. Five studies investigated ctDNA mutations in HNSCC. The most frequent examined gene mutation was TP53. Eleven studies investigated ctDNA methylations in HNSCC. Nine studies calculated the diagnostic accuracy of ctDNA methylations in HNSCC compared to controls. The most frequent examined gene methylations were CDKN2A, DAPK1, RASSF1, and P15.Conclusion We found that increasing the number of ctDNA genetic methylations resulted in an increase in diagnostic sensitivity accuracy. No studies investigating ctDNA mutations included a control group. A combination of multiple human ctDNA gene alterations with viral ctDNA are promising tools for developing a ctDNA biomarker for HNSCC.Background Post-traumatic stress disorder (PTSD) is common among resettled refugee populations and may be particularly problematic for refugees who have resettled in rural and regional areas.Aims The aim of this study was to examine the occurrence and correlates of PTSD among Afghan refugees resettled in a regional area of Australia, namely, Launceston, Tasmania.Methods A cross-sectional survey was conducted with 66 resettled Afghan refugees living in Launceston using the Post Migration Living Difficulties Scale (PMLD) and Impact of Event Scale-Revised (IES-R). Descriptive statistics and multivariable analysis of variables associated with a probable diagnosis of PTSD were conducted.Results Approximately half of participants 48.8% (95% CI 36.0-61.1%) met an operational definition of probable PTSD diagnosis according to the IES-R. In multivariable logistic regression analysis, communication difficulties (OR = 14.6, 95% CI 1.7-124.7), separation from family (OR = 9.9, 95% CI 1.8-55.5), and self-recognition of a mental health problem (OR = 13.8, 95% CI 2.4-80.0) were strongly and independently associated with probable PTSD diagnosis. While most participants (81.2%) with a probable PTSD diagnosis recognised that they had a mental health problem, less than half (46.9%) had sought professional help for such a problem.Conclusions The findings suggest that there are high rates of PTSD, and relatively low uptake of mental health care by sufferers, among resettled Afghan refugees in the regional area of Launceston, Australia. Factors that might usefully be targeted in health promotion, prevention and early intervention program include communication difficulties, issues of family separation and isolation and aspects of "mental health literacy" likely to detract from help-seeking.Objective To determine the impact of maternal age on the rate of cesarean delivery in women undergoing induction at term.Study Design Retrospective cohort study of term singleton gestations in nulliparous women induced for any indication at Lehigh Valley Health Network from July 2010 to July 2013. Exposure of interest was maternal age. Primary outcome was cesarean delivery. For every one woman ≥35 years of age (exposed), 2-3 women less then 35 years of age were selected as unexposed subjects for comparison. Statistical analysis included bivariate and multivariable techniques.Results 406 patients were included; 101 women ≥35 years of age and 305 women less then 35 years of age. Women in the ≥35 group were more likely to be induced for maternal medical conditions and less likely to be induced for prolonged pregnancy; few inductions were elective. Few women were induced electively in either group. More than half of women in both groups required cervical ripening. Method of cervical ripening and/or induction and percentage of women with a Bishop score less then 5 were similar between groups. The primary outcome, cesarean delivery, was similar between groups (45.5% in age ≥35 group vs 40.0% in age less then 35 group, p = .33). After adjustment for potential confounders, the rate of cesarean delivery was not influenced by maternal age (AOR 1.21 [0.76, 1.91], p = .42) but was higher in women with a Bishop score less then 5 at the time of induction of labor [AOR 1.64 [1.09, 2.47], p = .02].Conclusion In the wake of several recent trials underscoring the safety and potential maternal and fetal benefit of labor induction, identifying predictors of induction success (and failure) takes on increasing importance. Our findings suggest that maternal age is not an independent risk factor for cesarean delivery in women undergoing induction.