bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Organizational Socialization in Preservice Teachers’ Delivery of Sport Education
Authors: Deenihan Jeremiah T. , MacPhail Ann
Published: March 2017

Research investigating teachers’ and preservice teachers’ (PSTs) experiences delivering Sport Education (SE) necessitates further attention (Glotova & Hastie, 2014). Research that has been conducted to date has shared varied findings, with some teachers finding it difficult to teach SE in its entirety (Curtner-Smith, Hastie, & Kinchin, 2008). This study investigated seven PSTs’ delivery of SE during their teaching placement in the final year of their physical education teacher education (PETE) program. Data were gathered through pre- and postteaching placement interviews and midteaching placement focus groups, which were analyzed using thematic coding and constant comparison (Miles & Huberman, 1994; Thomas, 2009). Occupational socialization (Lawson, 1983a, 1983b) was used as the framework to analyze the factors that influenced their learning and delivery of SE. Findings show that PSTs encountered specific difficulties related to teaching SE on teaching placement and that their cooperating teachers played a significant role in their delivery of SE.
Resistance Exercise and Youth: Survival of the Strongest
Authors: Faigenbaum Avery
Published: March 2017

Research evidence continues to define the unique health- and performance-related benefits of resistance exercise for children and adolescents. While the effectiveness of resistance exercise in increasing muscle strength and motor skill performance has been demonstrated repeatedly, current scientific evidence indicates that the right “dose” of resistance exercise can enhance physical performance in young athletes and reduce the risk of developing cardiometabolic disease. The papers discussed in this commentary add to our understanding of the potential benefits of youth resistance exercise by defining dose-response relationships for key training variables, exploring sex-specific adaptations to this type of training, and examining the relationship between muscular strength early in life and cardiometabolic risk later in life. Noteworthy is the identification of unique, sex-specific thresholds for normalized strength to detect high risk cardiometabolic phenotypes in youth. New insights indicate that stronger boys and girls will be better prepared for sport and for life.
Immune Response to Exercise During Growth
Authors: Radom-Aizik Shlomit
Published: March 2017

Two papers were selected for this commentary. The first paper (Citation 1) suggests that a 10-week, moderate-intensity exercise program performed early after allogeneic hematopoietic stem cell transplantation is feasible in this fragile population, and might improve cell cytotoxicity by redistributing subpopulations of NK cells. This study adds to the growing evidence that enhancing immune cell surveillance (e.g., NK cells) in response to exercise could benefit cancer patients. The second paper (Citation 2) studied neutrophil-related mediators of oxidative stress and inflammatory cytokines in response to exercise in children compared with adults. The authors found age/maturation-related differences in these responses. The paper provides a valuable introduction to the current knowledge of maturational changes in immune mediators’ response to exercise. Data about leukocyte function in response to exercise in healthy children and in children with clinical conditions is scant. The need for prospective large scale pediatric clinical exercise studies is clear. Molecular approaches to understand the mechanisms through which physical activity can improve health will help to shape guidelines that optimize the mode, frequency, intensity, and duration of the training intervention.
Growth, Maturation and Exercise During Youth—2016
Authors: Jürimäe Jaak
Published: March 2017

For The Year that Was—2016, I have selected three papers in the area of growth, maturation, and exercise during youth. The year of 2016 was a successful year and it was not an easy task to highlight the most significant publications in this specific area of pediatric exercise science. The first paper has been chosen because it provides, for the first time, the growth and maturational status of elite junior tennis players belonging to the top eight players in the National rankings in various ages and compares against population norms. It appeared that individual differences in growth and maturation contribute towards the selection of elite junior tennis players in both sexes, with a bias towards these athletes who are comparatively tall and heavy for their age already in younger ages. The second paper is a methodological paper and was selected because it provides a unique perspective on the use of different tracking coefficients to investigate short-term tracking of cardiorespiratory and performance-related physical fitness among adolescents during growth and maturation. Specifically, three distinct statistical approaches were applied in this paper: auto-correlations, mulitilevel modeling corrected tracking values for time-varying covariates and Cohen`s Kappa in order to identify group and individual tracking as well as individuals whose trajectories are unstable across time. This methodological paper demonstrated the importance of the selection of the statistical approach to monitor and describe short-term tracking of cardiorespiratory and performance-related physical fitness variables in adolescents during growth and maturation. The third selected paper provided some evidence that the consequence of physical activity during childhood can be far reaching as physical activity might not only promote health benefits but also have positive effects on adulthood earnings.
Physical Activity, Inactivity and Health During Youth—2016
Authors: Rowlands Alex V.
Published: March 2017

2016 has been an exciting year for research in physical activity, inactivity and health. Recognition of the importance of all physical behaviors (physical activity, sedentary time and sleep) across the 24-hr day continues to grow. Notable advances have included: applications of recent methodological innovations that account for the codependence of the behaviors in the finite 24-hr period showing that the balance of these behaviors is associated with health; methodological innovations focusing on the classification of behaviors and/or quantification of the 24-hr diurnal activity pattern; and a series of systematic reviews that helped provide the evidence base for the release of the innovative 24-hr movement guidelines earlier this year. This commentary focuses on just two of these papers: the first by Goldsmith and colleagues who demonstrate a new statistical method that exploits the time series nature of accelerometer data facilitating new insights into time-specific determinants of children’s activity patterns and associations with health; the second by Tremblay and colleagues who describe the evidence base for associations between each physical behavior and children’s health, the emerging evidence base for associations between the balance of behaviors and health, and development of the world’s first 24-hr movement guidelines.
Pediatric Aerobic Fitness and Trainability
Authors: Armstrong Neil
Published: March 2017

Three papers which between them raise controversial issues, apply laboratory measures to sport performance, and expose gaps in knowledge were selected for commentary. The first paper (Sports Med. 2016;46:1451–1460) reviews the literature on peak V̇O2 in relation to body size and recommends that peak V̇O2 in youth is best expressed via allometric scaling of lean body mass. The second paper (Pediatr Exerc Sci. 2016;28:456–465) reports that maturity status has no effect on peak V̇O2, respiratory compensation point, or ventilatory threshold in youth soccer players once data have been allometrically normalized by lower limb muscle volume. It concludes that in future this technique should be used to compare the aerobic fitness of youth soccer players. The third paper (Eur J Appl Physiol. 2016;116:1781–1794) demonstrates that V̇O2 kinetics determined in a laboratory is related to measures associated with soccer match play and might distinguish superior performance within a group of highly trained youth players. The commentary stresses the importance of experimental rigor, emphasizes the need for appropriate scaling of physiological variables, challenges spurious correlations with health-related variables, endorses the use of a range of aerobic fitness measures, welcomes the application of laboratory data to sport performance, and identifies areas for future research.
Endocrinology and Pediatric Exercise Science—2016
Authors: Eliakim Alon
Published: March 2017

The Pediatric Exercise Science Year That Was section aims to highlight the most important (to the author’s opinion) manuscripts that were published in 2016 in the field of endocrinology and pediatric exercise science. This year’s selection includes studies showing that 1) Induction of T4 to T3 conversion by type 2 deiodinase following aerobic exercise in skeletal muscles was associated with concomitant increase in peroxisome proliferatoractivated receptor-γ coactivator-1α, and mitochondrial oxidative capacity and therefore plays an important mechanistic role in the muscle adaptation to exercise training. 2) Hypothyroidism in fetal and early postnatal life was associated with impaired spatial learning and memory and with reduced hippocampal brain-derived neurotrophic factor in male and female rat pups. Forced (treadmill) and voluntary (wheel) exercise alleviated all these biochemical and neuro-cognitive deficits. 3) The relationship between different exercise intensities and carbohydrate requirements to maintain euglycemia at basal insulin levels among adolescent and young adults with Type 1 diabetes are nonlinear but rather inverted- U with no exogenous glucose required to maintain stable glucose level at high-intensity exercise (80%). The implication of these studies to the pediatric population, their importance and the new research avenues that were opened by these studies is emphasized.
Cardiovascular Physiology and Disease in Youth—2016
Authors: Rowland Thomas
Published: March 2017

The two articles in the area of cardiovascular physiology and disease in youth were chosen for commentary because of their exploration of new approaches to the diagnosis and management of cardiovascular derangements in young persons. The first, by Hinds et al., describes the potential clinical importance of detection of cardiovascular changes during exercise testing in adolescent athletes following concussions. This approach might prove useful in establishing safe return-to-play guidelines. The second, a review article by Van De Schoor et al, evaluates the frequency of myocardial scarring in athletes, some of adolescent age, which is a recognized risk factor for sudden cardiac death. These findings support other evidence indicating that sports participation per se might rarely increase the risk of such tragedies. Clearly more research is indicated by the information raised in both of these articles, but their importance to clinical medicine is obvious.
Exercise and Cognition—2016
Authors: Tomporowski Phillip D.
Published: March 2017

Physical activity is purported to promote children’s brain health and enhance mental development (1). Three studies were selected for review because of their focus on issues that challenge translational research applications in exercise pediatric science. While some disagreement exists concerning the definition of translational research, most suggest that translational interventions focus on the uptake, implementation, and sustainability of research findings within standard care (2). Translational researchers typically highlight differences that exist between efficacy experiments, which provide evidence that a specific intervention works, and effectiveness experiments, which show that the intervention will reap benefits under real-world conditions. Results obtained from laboratory-based efficacy studies that have examined the relation between exercise and cognition led researchers (3,4) and policy makers to consider the importance of physical activity in school settings. Large-scale studies that assess the impact of various types of school based physical activity intervention on children’s cognitive and academic performance have begun. The initial results have been uneven and suggestive of a lack of benefit for children in authentic school settings. Before drawing such conclusions, however, it will be important for researchers and practitioners to recognize the methodological and measurement issues that challenge attempts to employ laboratory methodologies to academic settings.
An oral microjet vaccination system elicits antibody production in rabbits
Authors: Aran Kiana , Chooljian Marc , Paredes Jacobo , Rafi Mohammad , Lee Kunwoo , Kim Allison Y. , An Jeanny , Yau Jennifer F. , Chum Helen , Conboy Irina , Murthy Niren , Liepmann Dorian
Published: March 2017

A needle-free device delivers a liquid jet of vaccine that penetrates the buccal mucosa and elicits antibody production in rabbits.
Human Cytomegalovirus MicroRNAs miR-US5-1 and miR-UL112-3p Block Proinflammatory Cytokine Production in Response to NF-κB-Activating Factors through Direct Downregulation of IKKα and IKKβ
Authors: Hancock Meaghan H. , Hook Lauren M. , Mitchell Jennifer , Nelson Jay A.
Published: March 2017

Emerging evidence indicates that human cytomegalovirus (HCMV) manipulates host cell signaling pathways using both proteins and noncoding RNAs. Several studies have shown that HCMV induces NF-κB signaling early in infection, resulting in the induction of antiviral proinflammatory cytokines with a subsequent reduction of these cytokines late in infection. The mechanism for late cytokine reduction is unknown. In this study, we show that HCMV microRNAs (miRNAs) miR-US5-1 and miR-UL112-3p target the IκB kinase (IKK) complex components IKKα and IKKβ to limit production of proinflammatory cytokines in response to interleukin 1β (IL-1β) and tumor necrosis factor alpha (TNF-α). Transfection of miR-UL112-3p and miR-US5-1 mimics reduced endogenous IKKα and IKKβ protein levels, and site-directed mutagenesis of the 3′ untranslated regions (UTRs) identified the binding sites for each miRNA. Infection with mutant viruses lacking these miRNAs resulted in increased levels of IKKα and IKKβ proteins, an impaired ability to control NF-κB signaling at late times of lytic infection, and increased production of proinflammatory cytokines compared to wild-type virus in cell types relevant to HCMV infectionin vivo. These phenotypes were rescued by preexpression of miR-US5-1 and miR-UL112-3p in infected cells or by a miR-US5-1/miR-UL112-3p double mutant virus that expresses short hairpin RNAs (shRNAs) targeting IKKα and IKKβ, demonstrating the gene specificity of the miRNAs. These observations describe a mechanism through which HCMV miRNAs expressed late in the infectious cycle downregulate proinflammatory cytokine production to create a cellular proviral environment.

IMPORTANCEHuman cytomegalovirus (HCMV) is a significant cause of morbidity and mortality in transplant recipients and causes hearing loss and mental retardation when acquired congenitally. Initial events during HCMV infection result in the activation of NF-κB signaling, which culminates in the production of IL-6, CCL5, and TNF-α. Several viruses have developed mechanisms to block the antiviral effects of these cytokines. We show here that two HCMV miRNAs, miR-US5-1 and miR-UL112-3p, specifically downregulate IKKα and IKKβ signaling factors necessary to propagate NF-κB signaling and subsequent IL-6, CCL5, and TNF-α production. Regulation of these proinflammatory cytokines during lytic infection and during latency is critical to viral survival in the host.
Microevolution of Serial Clinical Isolates ofCryptococcus neoformansvar.grubiiandC. gattii
Authors: Chen Yuan , Farrer Rhys A. , Giamberardino Charles , Sakthikumar Sharadha , Jones Alexander , Yang Timothy , Tenor Jennifer L. , Wagih Omar , Van Wyk Marelize , Govender Nelesh P. , Mitchell Thomas G. , Litvintseva Anastasia P. , Cuomo Christina A. , Perfect John R.
Published: March 2017

The pathogenic species ofCryptococcusare a major cause of mortality owing to severe infections in immunocompromised as well as immunocompetent individuals. Although antifungal treatment is usually effective, many patients relapse after treatment, and in such cases, comparative analyses of the genomes of incident and relapse isolates may reveal evidence of determinative, microevolutionary changes within the host. Here, we analyzed serial isolates cultured from cerebrospinal fluid specimens of 18 South African patients with recurrent cryptococcal meningitis. The time between collection of the incident isolates and collection of the relapse isolates ranged from 124 days to 290 days, and the analyses revealed that, during this period within the patients, the isolates underwent several genetic and phenotypic changes. Considering the vast genetic diversity of cryptococcal isolates in sub-Saharan Africa, it was not surprising to find that the relapse isolates had acquired different genetic and correlative phenotypic changes. They exhibited various mechanisms for enhancing virulence, such as growth at 39°C, adaptation to stress, and capsule production; a remarkable amplification ofERG11at the native and unlinked locus may provide stable resistance to fluconazole. Our data provide a deeper understanding of the microevolution ofCryptococcusspecies under pressure from antifungal chemotherapy and host immune responses. This investigation clearly suggests a promising strategy to identify novel targets for improved diagnosis, therapy, and prognosis.

IMPORTANCEOpportunistic infections caused by species of the pathogenic yeastCryptococcuslead to chronic meningoencephalitis and continue to ravage thousands of patients with HIV/AIDS. Despite receiving antifungal treatment, over 10% of patients develop recurrent disease. In this study, we collected isolates ofCryptococcusfrom cerebrospinal fluid specimens of 18 patients at the time of their diagnosis and when they relapsed several months later. We then sequenced and compared the genomic DNAs of each pair of initial and relapse isolates. We also tested the isolates for several key properties related to cryptococcal virulence as well as for their susceptibility to the antifungal drug fluconazole. These analyses revealed that the relapsing isolates manifested multiple genetic and chromosomal changes that affected a variety of genes implicated in the pathogenicity ofCryptococcusor resistance to fluconazole. This application of comparative genomics to serial clinical isolates provides a blueprint for identifying the mechanisms whereby pathogenic microbes adapt within patients to prolong disease.
Bacteria Getting into Shape: Genetic Determinants of
E. coli
Morphology
Authors: French Shawn , Côté Jean-Philippe , Stokes Jonathan M. , Truant Ray , Brown Eric D.
Published: March 2017

Perturbation of cellular processes is a prevailing approach to understanding biology. To better understand the complicated biology that defines bacterial shape, a sensitive, high-content platform was developed to detect multiple morphological defect phenotypes using microscopy. We examined morphological phenotypes across the
Escherichia coli
K-12 deletion (Keio) collection at the mid-exponential growth phase, revealing 111 deletions perturbing shape. Interestingly, 64% of these were uncharacterized mutants, illustrating the complex nature of shape maintenance and regulation in bacteria. To understand the roles these genes play in defining morphology, 53 mutants with knockouts resulting in abnormal cell shape were crossed with the Keio collection in high throughput, generating 1,373 synthetic lethal interactions across 1.7 million double deletion mutants. This analysis yielded a highly populated interaction network spanning and linking multiple phenotypes, with a preponderance of interactions involved in transport, oxidation-reduction, and metabolic processes.

IMPORTANCE
Genetic perturbations of cellular functions are a prevailing approach to understanding cell systems, which are increasingly being practiced in very high throughput. Here, we report a high-content microscopy platform tailored to bacteria, which probes the impact of genetic mutation on cell morphology. This has particular utility in revealing elusive and subtle morphological phenotypes associated with blocks in nonessential cellular functions. We report 111 nonessential mutations impacting
E. coli
morphology, with nearly half of those genes being poorly annotated or uncharacterized. Further, these genes appear to be tightly linked to transport or redox processes within the cell. The screening platform is simple and low cost and is broadly applicable to any bacterial genomic library or chemical collection. Indeed, this is a powerful tool in understanding the biology behind bacterial shape.
Indirect Interspecies Regulation: Transcriptional and Physiological Responses of a Cyanobacterium to Heterotrophic Partnership
Authors: Bernstein Hans C. , McClure Ryan S. , Thiel Vera , Sadler Natalie C. , Kim Young-Mo , Chrisler William B. , Hill Eric A. , Bryant Donald A. , Romine Margaret F. , Jansson Janet K. , Fredrickson Jim K. , Beliaev Alexander S.
Published: March 2017

This study elucidates how a cyanobacterial primary producer acclimates to heterotrophic partnership by modulating the expression levels of key metabolic genes. Heterotrophic bacteria can indirectly regulate the physiology of the photoautotrophic primary producers, resulting in physiological changes identified here, such as increased intracellular ROS. Some of the interactions inferred from this model system represent putative principles of metabolic coupling in phototrophic-heterotrophic partnerships.
Severe lead toxicity attributed to bullet fragments retained in soft tissue
Authors: Weiss Debora , Lee Don , Feldman Ryan , Smith Kate E
Published: March 2017

A man aged 30 years presented to an emergency department with a 1 month history of severe abdominal pain, jaundice, constipation, lower extremity weakness and weight loss. A peripheral blood smear was performed that showed basophilic stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The patient had a BLL of >200 µg/dL. Retained bullet fragments were identified in the left lower extremity from a previous gunshot wound 10 years prior. Lead from the excised bullet fragment was consistent with the patient's blood lead by isotope ratio analysis. This case is a rare example of a severely elevated BLL attributed to bullet fragments in soft tissue. Bullets retained in soft tissue are not often considered a risk factor for a markedly elevated BLL because they become encapsulated within the tissue over time.
Heroin-associated anthrax with minimal morbidity
Authors: Black Heather , Chapman Ann , Inverarity Donald , Sinha Satyajit
Published: March 2017

In 2010, during an outbreak of anthrax affecting people who inject drugs, a heroin user aged 37 years presented with soft tissue infection. He subsequently was found to have anthrax. We describe his management and the difficulty in distinguishing anthrax from non-anthrax lesions. His full recovery, despite an overall mortality of 30% for injectional anthrax, demonstrates that some heroin-related anthrax cases can be managed predominately with oral antibiotics and minimal surgical intervention.
Reversal of isolated 20q deletion with vitamin B12replacement in a patient with pernicious anaemia
Authors: Cingam Shashank Reddy , Koshy Nebu , Veillon Diana , Peddi Prakash
Published: March 2017

Severe vitamin B12deficiency is well known to cause morphological alterations in bone marrow. In rare instances, these myelodysplastic and megaloblastic changes can coexist with cytogenetic abnormalities. Here, we report a case of a 38-year-old African-American woman with pernicious anaemia, who was found to have an isolated 20q deletion and which resolved after vitamin B12replacement. We also discuss various mechanisms in which vitamin B12deficiency can lead to chromosomal abnormalities. A literature review is also performed to evaluate various other chromosomal aberrations associated with B12deficiency.
Intellectual disability complicated by sexual addiction: an uncommon presentation of a common condition
Authors: Pang Nicholas Tze Ping , Masiran Ruziana
Published: March 2017

A young man presented with high libido for 3 years, associated with preoccupation with sexual thoughts combined with his pursuit of pornographic materials. He had strong psychological cravings for and had spent large amount of money on sex, resulting in a dispute with his family. There were no mood or psychotic symptoms. Medical history revealed recent diagnosis of gonococcal urethritis. Cognitive assessment showed subtle deficiencies in reasoning and executive functions. There was occasional use of alcohol. Sexual addiction with comorbid mild intellectual disability was diagnosed, and pharmacological as well as psychological management were started.
Out of the blue finger ischaemia and occult colorectal cancer
Authors: Schattner Ami
Published: March 2017

A woman aged 66 years with a history of unprovoked deep venous thrombosis (DVT) presented with persistent digital ischaemic changes of 2 of her right hand fingers. Physical examination was otherwise normal and extensive laboratory and imaging studies were unremarkable. A history of unprovoked DVT and the current episode of digital ischaemia prompted concern for underlying occult malignancy. Repeated history-taking revealed a strongly positive family history suggesting an occult colorectal cancer. Colonoscopy with biopsy revealed adenocarcinoma. Adenocarcinoma of the colon has rarely been associated with paraneoplastic acral vascular syndrome. This report suggests that occult malignancy needs to be considered in patients with focal digital ischaemia as this association is poorly unrecognised.
Ureteral inguinal hernia: an uncommon trap for general surgeons
Authors: Yahya Zarif , Al-habbal Yahya , Hassen Sayed
Published: March 2017

Inguinal hernias involving the ureter, a retroperitoneal structure, is an uncommon phenomenon. It can occur with or without obstructive uropathy, the latter posing a trap for the unassuming general surgeon performing a routine inguinal hernia repair. Ureteral inguinal hernia should be included as a differential when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure or urinary tract infection particularly in a male. The present case describes a patient with a known ureteroinguinal hernia who proceeded to having a planned hernia repair and ureteric protection. The case is a reminder that when faced with an unexpected finding such an indirect sliding inguinal hernia, extreme care should be taken to ensure that no structures are inadvertently damaged and that a rare possibility is the entrapment of the ureter in the inguinal canal.
Impact of the global financial crisis on low birth weight in Portugal: a time-trend analysis
Authors: Kana Musa Abubakar , Correia Sofia , Peleteiro Barbara , Severo Milton , Barros Henrique
Published: March 2017

Background

The 2007–2008 global financial crisis had adverse consequences on population health of affected European countries. Few contemporary studies have studied its effect on perinatal indicators with long-lasting influence on adult health. Therefore, in this study, we investigated the impact of the 2007–2008 global financial crisis on low birth weight (LBW) in Portugal.

Methods

Data on 2 045 155 singleton births of 1995–2014 were obtained from Statistics Portugal. Joinpoint regression analysis was performed to identify the years in which changes in LBW trends occurred, and to estimate the annual per cent changes (APC). LBW risk by time period expressed as prevalence ratios were computed using the Poisson regression. Contextual changes in sociodemographic and economic factors were provided by their trends.

Results

The joinpoint analysis identified 3 distinct periods (2 jointpoints) with different APC in LBW, corresponding to 1995–1999 (APC=4.4; 95% CI 3.2 to 5.6), 2000–2006 (APC=0.1; 95% CI −050 to 0.7) and 2007–2014 (APC=1.6; 95% CI 1.2 to 2.0). For non-Portuguese, it was, respectively, 1995–1999 (APC=1.4; 95% CI −3.9 to 7.0%), 2000–2007 (APC=−4.2; 95% CI −6.4 to −2.0) and 2008–2014 (APC=3.1; 95% CI 0.8 to 5.5). Compared with 1995–1999, all specific maternal characteristics had a 10–15% increase in LBW risk in 2000–2006 and a 20–25% increase in 2007–2014, except among migrants, for which LBW risk remained lower than in 1995–1999 but increased after the crisis. The increasing LBW risk coincides with a deceleration in gross domestic product growth rate, reduction in health expenditure, social protection allocation on family/children support and sickness.

Conclusions

The 2007–2008 global financial crisis was associated with a significant increase in LBW, particularly among infants of non-Portuguese mothers. We recommend strengthening social policies aimed at maternity protection for vulnerable mothers and health system maintenance of social equity in perinatal healthcare.
Statin prescribing for people with severe mental illnesses: a staggered cohort study of ‘real-world’ impacts
Authors: Blackburn R , Osborn D , Walters K , Falcaro M , Nazareth I , Petersen I
Published: March 2017

Objectives

To estimate the ‘real-world effectiveness of statins for primary prevention of cardiovascular disease (CVD) and for lipid modification in people with severe mental illnesses (SMI), including schizophrenia and bipolar disorder.

Design

Series of staggered cohorts. We estimated the effect of statin prescribing on CVD outcomes using a multivariable Poisson regression model or linear regression for cholesterol outcomes.

Setting

587 general practice (GP) surgeries across the UK reporting data to The Health Improvement Network.

Participants

All permanently registered GP patients aged 40–84 years between 2002 and 2012 who had a diagnosis of SMI. Exclusion criteria were pre-existing CVD, statin-contraindicating conditions or a statin prescription within the 24 months prior to the study start.

Exposure

One or more statin prescriptions during a 24-month ‘baseline’ period (vs no statin prescription during the same period).

Main outcome measures

The primary outcome was combined first myocardial infarction and stroke. All-cause mortality and total cholesterol concentration were secondary outcomes.

Results

We identified 2944 statin users and 42 886 statin non-users across the staggered cohorts. Statin prescribing was not associated with significant reduction in CVD events (incident rate ratio 0.89; 95% CI 0.68 to 1.15) or all-cause mortality (0.89; 95% CI 0.78 to 1.02). Statin prescribing was, however, associated with statistically significant reductions in total cholesterol of 1.2 mmol/L (95% CI 1.1 to 1.3) for up to 2 years after adjusting for differences in baseline characteristics. On average, total cholesterol decreased from 6.3 to 4.6 in statin users and 5.4 to 5.3 mmol/L in non-users.

Conclusions

We found that statin prescribing to people with SMI in UK primary care was effective for lipid modification but not CVD events. The latter finding may reflect insufficient power to detect a smaller effect size than that observed in randomised controlled trials of statins in people without SMI.
Does household access to improved water and sanitation in infancy and childhood predict better vocabulary test performance in Ethiopian, Indian, Peruvian and Vietnamese cohort studies?
Authors: Dearden Kirk A , Brennan Alana T , Behrman Jere R , Schott Whitney , Crookston Benjamin T , Humphries Debbie L , Penny Mary E , Fernald Lia C H
Published: March 2017

Objective

Test associations between household water and sanitation (W&S) and children's concurrent and subsequent Peabody Picture Vocabulary Test (PPVT) scores.

Design

Prospective cohort study.

Setting

Ethiopia, India, Peru, Vietnam.

Participants

7269 children.

Primary outcome measures

PPVT scores at 5 and 8 years. Key exposure variables were related to W&S, and collected at 1, 5 and 8 years, including ‘improved’ water (eg, piped, public tap or standpipe) and ‘improved’ toilets (eg, collection, storage, treatment and recycling of human excreta).

Results

Access to improved water at 1 year was associated with higher language scores at 5 years (3/4 unadjusted associations) and 8 years (4/4 unadjusted associations). Ethiopian children with access to improved water at 1 year had test scores that were 0.26 SD (95% CI 0.17 to 0.36) higher at 5 years than children without access. Access to improved water at 5 years was associated with higher concurrent PPVT scores (in 3/4 unadjusted associations), but not later scores (in 1/4 unadjusted associations). 5-year-old Peruvian children with access to improved water had better concurrent performance on the PPVT (0.44 SD, 95% CI 0.30 to 0.59) than children without access to improved water. Toilet access at 1 year was also associated with better PPVT scores at 5 years (3/4 unadjusted associations) and sometimes associated with test results at 8 years (2/4 unadjusted associations). Toilet access at 5 years was associated with concurrent PPVT scores (3/4 unadjusted associations). More than half of all associations in unadjusted models (water and toilets) persisted in adjusted models, particularly for toilets in India, Peru and Vietnam.

Conclusions

Access to ‘improved’ water and toilets had independent associations with children's PPVT scores that often persisted with adjustment for covariates. Our findings suggest that effects of W&S may go beyond subacute and acute infections and physical growth to include children's language performance, a critical component of cognitive development.
Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
Authors: Spencer Sandra , Nypaver MIchele , Hebert Katherine , Benner Christopher , Stanley Rachel , Cohen Daniel , Rogers Alexander , Goldstick Jason , Mahajan Prashant
Published: March 2017

Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery (< 60 minutes) has been shown to reduce mortality.

We compared patient outcomes and describe interventions from three separate quality improvement (QI) projects conducted in three United States (US) tertiary care pediatric emergency departments (EDs) with the shared aim to reduce time to antibiotic (TTA) to < 60 minutes in febrile pediatric oncology patients (Temperature > 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers.

We conducted a post project analysis of prospectively collected observational data from children < 18 years visiting these EDs during independently conducted QI projects. Comparisons were made pre to post intervention periods within each institution.

All interventions were derived independently using QI methods by each institution. Successful as well as unsuccessful interventions were described and common interventions adopted by all sites identified.

A total of 1032 ED patient visits were identified from the three projects. Improvement in median TTA delivery (min) pre to post intervention(s) was 118.5–57.0 at site 1, 163.0–97.5 at site 2, and 188.0–111.5 at site 3 (p<.001 all sites). The eight common interventions were 1) Triage application of topical anesthetic 2) Rapid room placement & triage 3) Resuscitation room placement of ill appearing children 4) Close proximity to central line equipment 5) Antibiotic administration before laboratory analyses 6) Consensus clinical practice guideline establishment 7) Family pre-ED education for fever and 8) Staff project updates.

This core set of eight low cost, high yield QI interventions were developed independently by the three ED's which led to substantial reduction in time to antibiotic delivery in children with cancer presenting with fever. These interventions may inform future QI initiatives in other settings caring for febrile pediatric oncology patients.
Affording opportunities to discuss deterioration in paediatric palliative care consultations: a conversation analytic study
Authors: Ekberg Stuart , Danby Susan , Herbert Anthony , Bradford Natalie K , Yates Patsy
Published: March 2017

Objective

Discussing the potential deterioration of a child who has a life-limiting condition has recognised benefits for future care, but can be challenging in a clinical context where uncertain illness trajectories are common. Existing research is restricted to indirect forms of evidence such as self-report data from clinicians and families. This study directly explores how discussions about deterioration are managed within actual paediatric palliative care consultations.

Methods

9 consultations were video recorded in an Australian paediatric palliative care service. Each consultation involved the same paediatric palliative care specialist. Conversation analysis was used to identify and explore recurrent ways in which discussions about deterioration came to be realised.

Findings

The study identified two communicative practices used by a paediatric palliative care specialist that afforded opportunities to discuss deterioration: (1) soliciting the family's agenda for the consultation; (2) initiating and maintaining topics where discussing deterioration is a relevant possibility. Across these different practices, a common feature was indirect initiation of discussions about deterioration. This approach made such discussions possible, but without mandating or even suggesting that such discussion must occur.

Conclusions

These communicative practices balance the benefit of discussing deterioration against a recognised importance of allowing discussions to be directed by a child's family. This was achieved by creating opportunities for discussing deterioration, without making such discussions necessary.
Management of pregnancy and obstetric complications in prehospital trauma care: prehospital resuscitative hysterotomy/perimortem caesarean section
Authors: Battaloglu Emir , Porter Keith
Published: March 2017

The need for prehospital resuscitative hysterotomy/perimortem caesarean section is rare. The procedures can be daunting and clinically challenging for practitioners. Maternal death can be averted by swift and decisive action. This guideline serves to inform prehospital practitioners about conducting maternal resuscitation following cardiac arrest, provides an evidence-based framework to support decision making and highlights areas for improvement in prehospital care.
Do differences in religious affiliation explain high levels of excess mortality in the UK?
Authors: Ralston Kevin , Walsh David , Feng Zhiqiang , Dibben Chris , McCartney Gerry , O'Reilly Dermot
Published: March 2017

Background

High levels of mortality not explained by differences in socioeconomic status (SES) have been observed for Scotland and its largest city, Glasgow, compared with elsewhere in the UK. Previous cross-sectional research highlighted potentially relevant differences in social capital, including religious social capital (the benefits of social participation in organised religion). The aim of this study was to use longitudinal data to assess whether religious affiliation (as measured in UK censuses) attenuated the high levels of Scottish excess mortality.

Methods

The study used the Scottish Longitudinal Study (SLS) and the ONS Longitudinal Study of England and Wales. Risk of all-cause mortality (2001–2010) was compared between residents aged 35 and 74 years of Scotland and England and Wales, and between Glasgow and Liverpool/Manchester, using Poisson regression. Models adjusted for age, gender, SES and religious affiliation. Similar country-based analyses were undertaken for suicide.

Results

After adjustment for age, gender and SES, all-cause mortality was 9% higher in Scotland than in England and Wales, and 27% higher in Glasgow than in Liverpool or Manchester. Religious affiliation was notably lower across Scotland; but, its inclusion in the models did not attenuate the level of Scottish excess all-cause mortality, and only marginally lowered the differences in risk of suicide.

Conclusions

Differences in religious affiliation do not explain the higher mortality rates in Scotland compared with the rest of the UK. However, it is possible that other aspects of religion such as religiosity or religious participation which were not assessed here may still be important.
Association between income trajectories in childhood and psychiatric disorder: a Swedish population-based study
Authors: Björkenstam Emma , Cheng Siwei , Burström Bo , Pebley Anne R , Björkenstam Charlotte , Kosidou Kyriaki
Published: March 2017

Background

Childhood family income variation is an understudied aspect of households' economic context that may have distinct consequences for children. We identified trajectories of childhood family income over a 12-year period, and examined associations between these trajectories and later psychiatric disorders, among individuals born in Sweden between 1987 and 1991 (n=534 294).

Methods

We used annual income data between the ages of 3–14 years and identified 5 trajectories (2 high-income upward, 1 downward and 2 low-income upward trajectories). Psychiatric disorders in the follow-up period after age 15 were defined from International Classification of Disease (ICD)-codes in a nationwide patient register. Multiadjusted risks for all psychiatric disorders, as well as for specific psychiatric diagnoses, were calculated as HRs with 95% CIs.

Results

Of the 5 identified income trajectories, the constant low and the downward trajectories were particularly associated with later psychiatric disorder. Children with these trajectories had increased risks for psychiatric disorder, including mood, anxiety, psychotic disorders and attention deficit/hyperactivity disorder. The association remained, even after adjusting for important variables including parental psychiatric disorder. In contrast, the relationship was reversed for eating disorders, for which children in higher income trajectories had elevated risks.

Conclusions

Findings show that children growing up in a household characterised by low or decreasing family income have an increased risk for psychiatric disorder. Continued work is needed to reduce socioeconomic inequalities in psychiatric disorders. Policies and interventions for psychiatric disorders should consider the socioeconomic background of the family as an important risk or protective factor.
Impact of Elective versus Required Medical School Research Experiences on Career Outcomes
Authors: Weaver Alice N , McCaw Tyler R , Fifolt Matthew , Hites Lisle , Lorenz Robin G
Published: March 2017

Many US medical schools have added a scholarly or research requirement as a potential intervention to increase the number of medical students choosing to become academic physicians and physician scientists. We designed a retrospective qualitative survey study to evaluate the impact of medical school research at the University of Alabama at Birmingham (UAB) on career choices. A survey tool was developed consisting of 74 possible questions with built-in skip patterns to customize the survey to each participant. The survey was administered using the web-based program Qualtrics to UAB School of Medicine alumni graduating between 2000 and 2014. Alumni were contacted 3 times at 2-week intervals during the year 2015, resulting in 168 completed surveys (11.5% response rate). MD/PhD graduates were excluded from the study. Most respondents completed elective research, typically for reasons relating to career advancement. 24 per cent said medical school research increased their desire for research involvement in the future, a response that positively correlated with mentorship level and publication success. Although completion of medical school research was positively correlated with current research involvement, the strongest predictor for a physician scientist career was pre-existing passion for research (p=0.008). In contrast, students motivated primarily by curricular requirement were less likely to pursue additional research opportunities. Positive medical school research experiences were associated with increased postgraduate research in our study. However, we also identified a strong relationship between current research activity and passion for research, which may predate medical school.
Chemotherapy drug handling in first opinion small animal veterinary practices in the United Kingdom: results of a questionnaire survey
Authors: Edery E. G.
Published: March 2017

To investigate how first opinion small animal veterinary surgeons in the UK handled chemotherapeutic agents, a questionnaire was distributed at the 2014 British Small Animal Veterinary Association congress and by internet. Chemotherapy was regularly offered by 70.4 per cent of the respondents. Gold standards defined according to available guidelines for safe handling of antineoplastic drugs were poorly followed by general practitioners with only 2 per cent of respondents complying with all of them. Dedicated facilities for preparation and administration of cytotoxic drugs were variably available among participants. The level of training of staff indirectly involved in handling chemotherapy was appropriate in less than 50 per cent of practices. No association was found between demographic characteristics of the sampled population and the decision to perform chemotherapy. The results of this study raise concerns about the safety of the veterinary staff in first opinion practices involved in handling chemotherapy.
Caregiver placebo effect in analgesic clinical trials for cats with naturally occurring degenerative joint disease‐associated pain
Authors: Gruen M. E. , Dorman D. C. , Lascelles B. D. X.
Published: March 2017

A literature review identified six placebo‐controlled studies of analgesics in client‐owned cats with degenerative joint disease‐associated pain. Five studies with 96 cats had available data. Caregiver responses on a clinical metrology instrument, Client‐Specific Outcome Measure (CSOM), were compared to measured activity. Cats were categorised as ‘successes’ or ‘failures’ based on change in CSOM score and activity counts from baseline. Effect sizes based on CSOM score were calculated; factors that were associated with success/failure were analysed using logistic regression. Effect sizes ranged from 0.97 to 1.93. The caregiver placebo effect was high, with 54–74 per cent of placebo‐treated cats classified as CSOM successes compared with 10–63 per cent of cats classified as successes based on objectively measured activity. 36 per cent of CSOM successes were also activity successes, while 19 per cent of CSOM failures were activity successes. No significant effects of cat age, weight, baseline activity, radiographic score, orthopaedic pain score or study type on CSOM success in the placebo groups were found. The caregiver placebo effect across these clinical trials was remarkably high, making demonstration of efficacy for an analgesic above a placebo difficult. Further work is needed to determine whether a potential placebo‐by‐proxy effect could benefit cats in clinical settings.
Women physicists in Pakistan and my story of hard-earned success
Authors: Rani Malika
Published: March 2017

Education is a major factor of considerable importance in economic growth and stability of a country and especially women’s education plays a key role in the progress of any society. The present study reveals the current status of women physicists in Pakistan and my story of hard-earned success. I also discuss some issues that women face during higher education.