The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response.A community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations.Integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC , p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC  p<0.05).This study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV). Expanded Program on Immunization (EPI) has become one of the most successful public health programmes, reaching over 85% of the world's children . HoweverWHO and UNICEF developed the Global Immunization Vision and Strategy (GIVS), in 2005, to expand the reach of EPI, and prevent more disease . One of Justification for the study: The OTP centers are located few meters to the PHC centers where immunizations are being conducted and mothers were usually asked to go to the PHCC after being attended to at the OTP centers for their children immunization. However, it was observed that most of the children referred from the OTP centers to the PHCC for immunization services didn't go. During a focus group discussion conducted among the mothers/care givers some of the reasons given by the mothers/care givers for not taking their children for immunization at the PHCC when referred from OTP centers included being tired after spending some considerable time at the OTP centre and the need to go back home to continue their work or household chores. Some caregivers reported that on few occasions they went, the vaccinators were not around to provide the services or being asked to queue up again on getting to the clinic instead of being attended to immediately while others reported they forgot the immunization cards and had to go back home but late to go back to the clinic for that day leading to missed opportunity to improve immunization coverage in the camp.This was a community and health facility based interventional study during which immunization services were integrated with nutrition services in OTP centres and nutrition outreaches where immunization was previously not provided. All children under 5 years seen at the OTP centres and during nutrition community outreaches were all assessed for their immunization status and provided with appropriate immunization needed during the course of the study between January-December 2017. In the 2 OTP centers where the intervention was implemented, vaccinators were recruited to join the nutrition team to provide immunization in the OTP centre. During community outreaches and at the OTP centers the client flow as arranged so that all children who visited the centre either on follow up visit or new cases or during mass nutrition screening conducted by the Community Nutrition Volunteers were first assessed for immunization status before being screened or and enrolled into the nutrition program. The community nutrition volunteers were trained and supported to include health education and promotion messages on immunization in addition to the routine nutrition education and counselling being provided. In addition, during mass screening for malnutrition using MUAC tape being done and Infant and Young Child Feeding (IYCF) counselling the immunization status of all children were assessed and appropriate vaccination provided by the vaccinators who was part of the team. The community nutrition volunteers tracked children who defaulted from both the nutrition and immunization programs using the facility records and child health cards. The defaulter tracking was incorporated as part of the community outreaches so any child who had missed any immunization session was appropriately vaccinated. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services.Study site: The study was conducted in Bentiu Protection of civilian (PoC) site in Rubkona County, Unity State established in December 2013. There were 112,140 IDPs and 20,219 households seeking protection in the site and is divided into 5 sectors (sector 1-5) [tor 1-5) . There aSampling: Purposive sampling was used in the selection of the two OTP centres out of the 3 OTP centres in the camp used for the study. The two OTP centres (the only one in sector 2 and one out of the two in sector 5) were those the nutrition implementing partner agreed to integrate immunization into nutrition activities at OTP centres and community outreaches.Data collection and analysis: All immunised children were routinely tallied and recorded in the national immunization registers to ensure accuracy during immunization sessions both in the OTP and during outreaches and all children had their vaccination status recorded in the child health card every time immunized which was used to determine the next vaccines and identify any child who had missed any immunization sessions during defaulter tracking in the community. The immunization coverage for various antigens were analysed and the immunization coverage among children receiving nutrition services both through the OTP and outreaches was compared with the immunization coverage for various antigens in the primary health care centres which routinely provide immunization services. Data were entered and analyzed using STATA version 15 and excel analysis software. The primary outcome measure was receipt of appropriate antigens by children assessing nutrition services and the secondary outcome measure was dropout in vaccination. Proportions were calculated for categorical variables and summarized into tables and figure for univariate analysis. Bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. Odds Ratio (OR) and 95% Confidence Interval (95% CI) were used to estimate the strength of association between independent variables and the dependent variable. The threshold for statistical significance was set at p < 0.05. The dropout rate was calculated as a percentage of the difference between first and third pentavalent vaccine dose.Ethics approval and consent to participate: The State Ministry of Health, Liech State reviewed and cleared the use of data, contents and publication of this manuscript.The comparison analysis of the immunization data showed that more children were immunized with various antigens in 2017 than in 2016. In sector 2 in 2016, the total number of children immunized with BCG vaccine was 985 compared to 1366 vaccinated with BCG vaccines in 2017, likewise the number of children who received third dose of Oral polio vaccine was 987 in 2016 compared with 1653 in 2017. The number of children vaccine with third dose of pentavalent vaccine and measles were 1002 and 2693 respectively in 2016 which were less than 1783 and 3357 children vaccinated with third dose of Penta valent vaccine and measles respectively in 2017. Similarly, in sector 5 in 2016, the total number of children immunized with BCG vaccine was 1721 compared to 2045 vaccinated with BCG vaccines in 2017, likewise the number of children who received third dose of Oral polio vaccine was 1463 in 2016 compared with 2131 in 2017. The number of children vaccinated with third dose of pentavalent vaccine and measles were 1103 and 2987 respectively in 2016 which were less than 1917 and 3916 children vaccinated with third dose of Penta valent vaccine and measles respectively in 2017 .rd dose of Oral polio vaccine and Pentavalent vaccine respectively. A total of 1721(43.9%) and 743(30.3%) of children immunized in Sector 5 with measles and injectable polio vaccine respectively were immunized through the OTP centre  of them immunised with BCG vaccines while 502(30.5%) received the third dose of Oral Polio Vaccines, 687(41.2%) were vaccinated with the third dose of pentavalent vaccines and 1482(90%) vaccinated with measles vaccines. In sector 5 OTP centre, a total of 2712 malnourished children were enrolled into the nutrition program during the study with 934(34.4%) of them immunised with BCG vaccines, 951(35.1%) received the third dose of Oral Polio Vaccine, 1096(40.4%) vaccinated with the third dose of pentavalent vaccines and 1875(69.1 %) were vaccinated with measles vaccines . The anaP centre .rd dose of pentavalent vaccine ( Penta 3) and those who received 1st dose of the pentavalent vaccine(Penta 1) showed that in sector 2, among those children who received the first dose of pentavalent vaccine through the OTP centre, 8.9% did not return for their third dose of pentavalent vaccine while 26.8% of children who received the first does of pentavalent vaccine through the PHCC did not return for the third dose of pentavalent vaccines. In sector 5, among those children who received the first dose of pentavalent vaccine through the OTP centre, 12% did not return for their third dose of pentavalent vaccine while 35 % of children who received the first does of pentavalent vaccine through the PHCC did not return for the third dose of pentavalent vaccines. The acceptable limit is 10%  and the Global Immunization Vision and Strategy (GIV) and with adequate planning, integration can improve coverage, combine costs and create synergies. In order to deliver on the promise of Sustainable Development Goals 2 and 3 and dramatically reduce child mortality by 2030 we must ensure that every child has access to life-changing vaccines that not only provide protection against the leading causes of death in children under five, but also contribute to decreasing vulnerability to malnutrition.Limitation of the study: this study is based on review of clinic records and subject to the limitations associated with studies utilizing routine data. In addition, the study did not evaluate the possible impact of immunization status on the nutrition outcome among malnourished children who completed their immunization and those who dropped out.A child who is borderline nourished will tip into malnutrition if he or she contracts an infectious disease such as measles. As part of an integrated health approach, immunization plays a critical role in curbing the devastating impact of malnutrition;Immunization and Nutrition services are mostly vertical program in most countries.The number of children immunized through the integration in the nutrition services contributed greatly to the coverage of all immunization antigens in the project sites;Integration reduced greatly the missed opportunity for immunization services among the vulnerable population.The authors declare no competing interests.


The article presented an integrated data on talent management practices and innovation performance of academic staff in a technology-driven private university in Nigeria. The study adopted a quantitative approach with a survey research design to establish the major determinants of talent management practices. The population of this study included academic staff and the use of questionnaire was adopted to elicit from the study population. Data was analysed with the use of structural equation modelling and the field data set is made widely accessible to enable critical or a more comprehensive investigation. The findings identified talent development and retention strategies as predictors for facilitating innovation performance in the sample University. It was recommended that management of the sampled university will consistently need to adopt reliable range of strategies to attract and retain people for excellence performance. Talent management is a major determinant of organisational success but highly misconstrued in a competitive and demanding environment like the educational sector. Today, institutions especially the private universities in Nigeria are becoming more conscious of how and why talents need to be identified and managed. Several strategies have been put in place by many private universities to stimulate these practices, but despite the efforts, the issue of turnover, brain drift and low performance still become worrisome especially in the Nigeria׳s context.2The study is quantitative in nature and data were retrieved from staff (teaching and non-teaching) of Covenant University. This paper adopts the talent management measurement proposed by Winfield After validating the data collected from the survey, we further evaluated the structural relationships in the research model. We first use our data to test the benchmark model of Lee and Choi׳s χ2 is within the acceptable range of 1 and 3 as suggested by Browne and Cudeck Results in 3An empirical study was conducted to test the proposed research model. Survey instruments were distributed to 350 staff of the leading private university in Africa and has also emerged the winner of the Best Use of Technology Award 2016 among the private universities in Nigeria. The same University among others was awarded the Centenary ICT Driven University of the Year in 2014, the Overall Best University in Nigeria and West Africa and number 15 in Africa on the Webometric Ranking (February 2015) as well as African Private University of the Year (2015), by African Leadership Magazine Group in March, 2016.All participants were selected based on their substantive amount of work experience with the institution; as such they were able to provide useful information regarding the survey questions. Of those surveyed, only 313 respondents filled out and returned the questionnaire without missing or invalid data. Data were gathered from academic staff and non-academic staff directors, and other categories of employees across the institution with the aid of a researcher- made questionnaire based on the works of The collected data were coded and analysed using SPSS version 22. Data was analysed applying descriptive and inferential statistical tests. Importantly, the study participants were selected based on the following inclusion criteria:Inclusion criteria:•Participants were employees of the sampled technology-driven university.•Participants signed the consent form provided and have worked with the firm for a minimum period of 2 years.•Participants were accessible as at the time of the survey and interviews.This paper adopts the measurement proposed by Ueno Even though emerging issues in HRM have received much attention in the management literature over the last decade, only limited research has established how talent management practices can be used to drive on growth and prosperity for many organisations empirically. Motivated by a critical synthesis of literatures and consistent with prior research, our study shows that talent management practices improve innovation performance, which subsequently results in superior organizational performance. The researchers ensured that respondents were well informed about the background and the purpose of this research and they were kept abreast with the participation process. Respondents were offered the opportunity to stay anonymous and their responses were treated confidentially.


This letter has been written by the components of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification in response to a recent paper published by Mathes et al. :154) with the aim of drawing attention to the importance of the use of a metabolic marker to adapt protein intake in preterm infants. EMBA Working Group on Human Milk Fortification clarifies further the terminology and some specific aspects regarding individualized human milk fortification. There are two types of individualized human milk fortification: Adjustable human milk fortification and Targeted human milk fortification. Advantages and disadvantages of these methods are summarized. Dear Editor,We read with great interest the paper from Mathes et al.  which unWe appreciate the attempt of Mathes et al.  to searcOn the other hand we would like to remind them that there is a type of individualized HM fortification method, namely “adjustable fortification,” proposed in 2006 and comprises twice weekly assessments of blood urea nitrogen (BUN) as a marker of protein intake , 4.We are also aware that there is some confusion regarding the terminology around individualized human milk fortification, as we noticed previously , 6. TherThe nutrient and energy requirements stated in the international recommendations refer to the populations not individuals. We know that some infants will require more than the recommended intakes and some less. To find out how much protein an individual infant requires it is important to monitor the physiological response of each baby to the amount received and respond accordingly. In addition, protein and energy requirements may be particularly high in subgroups of infants for example those with bronchopulmonary dysplasia or extra-uterine growth restriction. Therefore fortification of HM should be adapted to specific nutrient needs of each individual infant. Adjustable human milk fortification in this sense is a good compromiseEuropean Milk Bank Association (EMBA) Working Group on Human Milk Fortification We greatly appreciate the clarification by the colleagues from the European Milk Bank Association and we agree to their comments.According to the data we were able to present in our original article (Ref ), it see


A critical approach in rural gerontology has led to a better understanding of the complex interplay between older adults unique aging experiences and the multidimensional and dynamic communities in which they live. The evolution of critical rural gerontology will be explored, outlining why a similar approach is needed in rural gerontological health. In particular, rural gerontological health literature must expand beyond a deficit focus that homogenizes older adult health experiences and recognize the complexities of negotiating older adult health within multidimensional rural spaces. Inherent in this approach is recognizing the intersectionality of older adult health as well as the need to study rural gerontological health as an experience enhanced and inhibited by interactions within and across formal health services, informal social services and informal care. This approach will contribute to innovations in policy and practice addressing the burgeoning interest of how to effectively care for older adults in rural settings.


Pediatric anesthesia has evolved as a subspecialty because the needs of infants and young children are fundamentally different from those of adults: they differ anatomically, physiologically, pharmacologically, emotionally and socially. Children who undergo anesthesia have special needs and all children have the right to receive the highest attainable standard of health in the right environment. The pediatric patient subjected to anesthesia is burdened by a significant increase in perioperative severe critical events that require unplanned immediate intervention to prevent the occurrence of disability or death. A recent pan-Europe multicentre studyThese important and recent data invite us to be aware that anesthesia for children should always be delivered by competent and appropriately experienced anesthesiologists and care teams. Children aged less than 3 years, ASA physical status ≥ III , with underlying congenital and metabolic diseases and/or undergoing major or complex surgery are those at highest risk for perioperative complications and poor outcome. It is recommended that these children should receive care by an anesthesiologist with specific education, training and ongoing experience in pediatric anesthesia. Anesthesiologists with mixed practice can deliver pediatric anesthesia for healthy children aged >3 years simple and routine procedures provided they have the adequate expertise and regular practice in pediatric anesthesia. They should maintain their competence and skills with regular exposure to pediatric lists and keep their knowledge up-to-date. The practice of pediatric anesthesia should be accompanied by continuous professional development (CPD).How to become a pediatric anesthesiologist? There is still no recognized framework for common and homogeneous pediatric anesthesia training in Europe. In the 90’s FEAPA (Federation of European Association of Pediatric Anesthesia later became ESPA European Society of Pediatric Anesthesia) made recommendations to certify training in pediatric anesthesia which were transposed unevenly in various European countries.However still today there are so many legislative differences among European countries that regulate the statutes of postgraduate training and also in the countries where pediatric anesthesia is recognized as a subspeciality  the duration of the fellowship, the supervision and the quality of training are different. There are currently only four national programs for maintenance of anesthesia certification, and these are available only in three countries In Italy, during postgraduate training we have pediatric anesthesia as part of compulsory professional activity  in the area core specialistic skills, but the duration and the quality of this training is very different among the University Postgraduate School. So SARNePI  and SIAARTI  have recently drafted a document in which they define who does what in the field of pediatric anesthesia.Children should receive pediatric anesthesia care in children’s hospitals or in general/district hospitals with dedicated pediatric areas. The pediatric population is too small to allow maintenance of sufficient skills for every anesthesiologist. Care of children undergoing anesthesia should ideally be regionalized in specialized pediatric settings staffed by pediatric anesthesiologists and pediatric nurses. In particular, the most vulnerable pediatric population, such as neonates and infants, those with co-morbidities and with underlying congenital and metabolic diseases as well as children undergoing major or complex surgery require referral to appropriately resourced multidisciplinary pediatric environments. Anesthesia for elective routine operations in otherwise stable and healthy children can be performed in district hospitals by teams with sufficient expertise in pediatric anesthesia. This requires appropriate staffing, equipment, facilities and support services.The most of pediatric surgery is performed in a healthy population, has a short duration and a recovery with few complications, so infants and children are well suited for ambulatory surgery. The frequency of pediatric ambulatory surgery has exploded such that 80–90% of pediatric surgery are now performed as ambulatory surgeryThe data we have available requires us centralizing children in the structure of reference with appropriately experienced anesthesiologists and care teams, but can we centralize all healthy children who undergo minor surgery? The answer is NO but the maximum competence of the personnel must be assured by guaranteeing a certain volume of activity. An adequate environment suitable for children with safety standards that must absolutely be present and centralize the most complex cases for pathology, for age and for comorbidity.


Explore associations between dietary patterns and maternal agePopulation based cohort studyMaternity department of a large hospital in northern EnglandWomen delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 .Survey data including maternal dietary patterns derived from food frequency questionnaire data using principal component analysis (PCA) were compared by maternal age using one-way ANOVA and chi-squared as appropriate.Dietary pattern PCA scores, supplement use, familiarity and compliance with 5-a-day fruit and vegetable recommendations, consumption of cola, maternal BMI.Three distinct dietary patterns were derived from the data; snack and processed foods, meat and fish and grains and starches. Mean PCA score for snack and processed foods was higher among women aged ≤19  than women aged 20–34  and those aged 35≥ . Women aged 35≥ had a significantly higher mean PCA score for the grains and starches dietary pattern  compared to both the 20–34 years  and the ≤19  groups. No differences were observed between groups in mean PCA scores for the meat and fish dietary pattern. Adolescent women also had higher intakes of sugar sweetened cola  and reported lower levels of fruit and vegetable and supplement intake. Women aged 35≥ had a higher mean BMI  and higher prevalence of overweight (36.8%) and obesity .Significant differences were observed between age groups both in terms of diet quality and BMI. Interventions targeted by age group may be advantageous in improving maternal nutrition and contribute to healthy pregnancies. Nutrition during pregnancy is a well-established modifiable factor which has the potential to impact upon the health and well-being of both mother and child. Study oOne such factor is the age of the mother during pregnancy. Adolescence is a time of substantial physiological change during which the nutritional needs of adolescent women are likely to differ from those of older women. Previous work examining the impact of maternal growth on outcomes in adolescent pregnancies suggested that nutrient partitioning between mother and child in growing adolescents negatively affected foetal growth and prematurity. A furthA recent systematic review of nutritional status of pregnant adolescents in developed countries found that intakes of energy, fibre and a number of micronutrients were below recommended levels in this population. The stuSimilar results were however reported in two reviews which were not confined to adolescent populations–7. This These previous works suggest that there may be nutritional issues that may impact on the health of both mother and child which vary by maternal age. This study therefore aims to assess differences in dietary pattern by maternal age in the Born in Bradford cohort.Born in Bradford is a largely bi-ethnic cohort of approximately 13,500 children with high levels of socio-economic deprivation. Pregnant women who were booked to deliver at Bradford Royal Infirmary were invited to join the cohort between March 2007 and December 2010. A detailed profile of the cohort has been published elsewhere. This stThe following demographic characteristics of the sample reported in the baseline questionnaire were explored; ethnicity, marital status, parity, education, smoking during pregnancy, alcohol and illegal drug use during pregnancy and index of multiple deprivation (IMD) score . Body maDue to the focus of this study being on detecting differences between age groups the study population was categorised into three groups for analysis according to maternal age; ≤19, 20–34 and 35≥ years, with women aged 20–34 being considered as the reference group. Statistical analysis was undertaken using SPSS 24.In order to evaluate nutrition in this population a series of statistical analyses were conducted using responses to the FFQ and applying principal component analysis (PCA) to identify distinct patterns of food types consumed. The FFQ was completed at 26–28 weeks gestation and refers to food intake during the preceding 4 weeks. There were a total of 37 items included in the FFQ, details of which are given with the results of the PCA. Since the original objective of the FFQ was to characterise the intakes of key food items only, it was not appropriate to derive an estimate of total energy intake. Responses to the food frequency questionnaire were given on either an eight  or five  point scale, these responses were therefore transformed to give an estimation of frequency per day in order to standardise questions asked in different formats.Individual items on the FFQ were then grouped by type and total frequency of consumption of different food groups estimated. The grouped nutritional variables were then used as the basis for a PCA in order to examine the dietary patterns which exist within the data set. PCA was selected as it allows for a larger number of variables to be reduced and underlying factors exposed.Differences between maternal age groups in both the demographic and nutrition related variables were explored using Chi-Square for categorical data and one-way ANOVA for continuous data; categorical variables are presented as percentages and continuous variables as means and 95% confidence intervals. Logistic regression analyses were used to compare the rate of each of the categorical nutrition related variables by age group and differences between groups estimated using odds ratios. Multivariate logistic regression models were then used to adjust these comparisons for confounding variables.Crude and adjusted odds ratios (OR and aOR) are therefore presented with 95% confidence intervals. Index of multiple deprivation (IMD) score and maternal ethnicity  were included as covariates in the adjusted analysis, due to the association of these variables with dietary pattern identified in the literature–12. WherIn the multivariate regression models for this study there is no clear logical or theoretical basis for assuming any variable to be prior to any other, either in terms of its relevance to the research goal of explaining phenomena, or in terms of a hypothetical causal structure of the data. For this reason a simultaneous method of including independent variables in the multivariate regression models was considered to be most appropriate, as opposed to a stepwise method.Due to the assumptions required to produce statistical models not being met for the dietary pattern scores  it was not possible to adjust the analysis of these variables for potentially confounding variables.Data were available for 5,083 pregnancies for this analysis; demographic characteristics of the participants included in the study are shown in Analysis of the nutrition related variables  showed tAdjustment for ethnicity and IMD score in the regression analysis produced similar results as shown in Several combinations of food groupings were explored to see which gave the most sensitive output in the PCA. These included loading all of the food items in separately, separating whole grains from other grains and starches, analysing all proteins as one group and separating proteins by type . The groupings outlined in When the analysis was completed without stipulating the number of factors to be retained two factors were retained which explained 43.8% of the total variance. On closer examination of the output, including examination of the inflection point of the scree plot, it was considered that a third and fourth factor with Eigen values of 0.971 and 0.939 respectively should be considered for inclusion. The analysis was therefore run with both 3 and 4 factors stipulated and the results compared with the initial analysis. The inclusion of a third factor presented a distinct dietary pattern which added to the logical understanding and interpretation of the data. The inclusion of a fourth factor did not however add to the understanding of the data. The decision was therefore made to retain 3 factors from the analysis, the inclusion of these 3 factors would then account for 55.9% of the total variance. Details of the retained factors and factor loadings are given in The analysis showed that there was an association between both the snacks and processed foods pattern and the grains and starches pattern and maternal age group . The meaThe results show an association between two of the dietary patterns in this analysis and maternal age. Strongest associations were seen in the snack and processed foods pattern where women aged ≤19 were found to have the highest mean PCA score reflecting a higher intake of foods that are typically viewed as snack items  and moderate intake of processed meat. Adolescent women also reported consuming higher levels of sugar sweetened cola compared to older women; no differences were observed in levels of consumption of artificially sweetened cola.There were no differences by age group in women's awareness of recommendations to eat five portions of fruit and vegetables per day; however adolescent women were less likely to say they achieve this recommendation. Adolescent women in the sample also reported the lowest use of nutritional supplements.Adolescent women had a higher prevalence of underweight (BMI <18.5) and older women a higher prevalence of overweight or obesity (BMI >25).These results are largely consistent with findings from the latest wave of the National Diet and Nutrition Survey (NDNS). ResultsThe findings of these studies are consistent with those of the present study however neither specifically addressed adolescent women or older women as distinct groups. As discussed in the introduction, the nutritional needs of adolescent women in particular may differ from those of older women due to the continued growth of the mother meaning that understanding the nutritional intake of young women during pregnancy is important. This study helps us to start to understand the dietary patterns associated with this group, however further work based on more robust dietary surveys is needed in order to improve understanding of this complex topic. A particular strength of this work is that it utilises well-established, ethnically diverse, UK based cohort data in a way which is unique to this study. This cohort includes a large number of participants meaning that analysis by maternal age including an adolescent group is both possible and robust.There were limitations in the dietary data available for this study. The number of items included in the FFQ was limited meaning that there is potential for the dietary patterns identified to be lacking in detail, or that additional patterns which might be present in the population could have been missed. This issue also resulted in the distribution of dietary pattern scores being significantly skewed, meaning that it was not possible to use statistical modelling to predict the extent to which maternal age influences dietary pattern, only that there appears to be an association. There was also no definition of portion size in the collection of data meaning there is likely to be significant variation between participants self-defined portion sizes. The FFQ was completed at 26–28 weeks of pregnancy and related to the preceding 4 weeks, meaning that the dietary patterns identified are only reliably relevant to the second trimester of pregnancy. Women's diet may change over the course of pregnancy meaning This study assesses dietary patterns ascertained by principal component analysis. Dietary patterns have been defined as "foods that are actually consumed in various characteristic combinations". The stuThe results suggest that there may be some cause for concern regarding the quality of adolescent pregnant women's diet, despite reporting similar levels of knowledge of recommendations to older women. This suggests that factors other than knowledge may be important in developing behaviour change interventions. There are a number of different theoretical models discussing the process of translating knowledge into action in public health. For example the health belief model is basedThe adolescent women in the sample also reported less use of nutritional supplements compared to the reference group. This suggests that any gaps in the nutritional profile of young women during pregnancy as a result of a sub-optimal diet may not be being filled by supplementary vitamins and minerals and may therefore leave women in this group with nutrient deficiencies.Consumption of sugar and artificially sweetened cola in this cohort has previously been examined with resEnergy intake was not available for analysis in this dataset meaning that maternal BMI at booking appointment is a useful indicator. Individual differences in total energy intake are largely determined by a combination of body size, physical activity and metabolic efficiency. Measurements of energy intake and physical activity in epidemiology are often crude and suffer from under or over reporting, and metabolic efficiency is essentially impossible to measure in this setting. For these reasons height and weight measurements are often considered a suitable alternative to measures of energy intake. The resThe results of this study are consistent with previous work assessing maternal obesity in the UK. This woThere may be some cause for concern with regard to diet quality in adolescent women and obesity among older women during pregnancy. Further work using more comprehensive methods of dietary data collection would be advantageous in assessing the nature of these relationships.The impact of dietary pattern on birth outcomes is also an important area for further work, particularly in light of evidence presented previously that there is a higher risk of extremely low birthweight babies and extremely pre-term delivery among adolescent women in this cohort.Interventions targeted to specific age groups to facilitate behaviour change may be useful due to differences identified in the types of nutritional issues affecting pregnant women at different ages. There is a need to further understand the barriers to healthy eating during pregnancy in order to develop successful interventions.


Several studies have investigated longitudinal changes in health status and functional ability but few have examined whether inequalities in healthy ageing varied across different countries. The aim of this study is to investigate trajectories of health metric scores (generated in previous symposium abstract) over the ageing process and examine the impact of education and wealth on the trajectories across eight cohorts in the ATHLOS consortium  using multilevel regression modelling. After adjusting for age, gender and study, higher levels of education  and wealth  were associated with higher baseline scores but had minimal impacts on decline rates. These effect sizes varied across different cohort studies and the inequality gradient was found to be strongest in the Health Retirement Study from US. Future research may investigate potential mechanisms which might explain the differential impact of education and wealth in different societies.


According to the “use it or lose it” hypothesis of cognitive aging, cognitive enrichment and cognitively engaging activities are associated with the maintenance of high levels of cognitive functioning in old age. Similar ideas have been brought forward with respect to characteristics of individuals’ work environment, with more cognitively enriching work demands providing an optimal environment for cognitive development and maintenance. The goal of this research group is to showcase new developments in research on work, retirement and cognitive aging. Hülür et al. examine the role of perceived work environment for cohort differences in trajectories of cognitive change based on 56-year longitudinal data from the Seattle Longitudinal Study. Andel et al. use data from the Swedish Adoption/Twin Study of Aging to examine trajectories of cognitive aging before vs. after retirement with two-slope growth curve models. Zulka et al. conduct a systematic literature review on the association between retirement and cognition and examine the role of factors such as occupational experiences and the cognitive domain studied. Burzynska et al. investigate the relationship between stressful and stimulating occupational exposures and structural brain health and cognition in older age. The discussion by George Rebok will focus on how these findings contribute to our understanding of the role of occupational experiences for cognitive and brain aging and how they can be utilized to promote maintenance of cognitive functioning in old age.


Osteoporosis is largely undetected and untreated in older men who are at-risk, with even lower rates of detection and treatment in rural communities. In this presentation we report the consequences for primary care providers (PCPs) of the implementation of an osteoporosis telemedicine clinic that targeted rural patients and is purposefully designed to minimize PCP workload. Analysis of qualitative interviews with PCPs who co-managed patients with the telemedicine clinic confirmed that implementation strategies used by the telemedicine clinic were successful at minimizing workload and had a positive impact on PCPs’ work. However, the clinic’s seamless approach may have contributed to unintended consequences of low PCP awareness of program care processes and selection criteria and a missed opportunity for PCPs to reinforce osteoporosis care goals in the primary care setting.


The creation and maintenance of sustainable data archives can be challenging but it offers clear advantage. Properly curated data can be used by multiple researchers, testing a variety of hypotheses and increasing the return on investment to the expensive process of data collection. Having an internally managed archival system also provides greater control and autonomy in the equitable distribution of data resources, insuring all researchers have full use of the data for original research, teaching and new directions once the data leaves the control of the local investigator’s control. This poster reviews the advantages of having a local strategy geared toward the preservation and sharing of gerontological research data. Using the National Archive of Computerized Data on Aging (NACDA) as a working example, the poster offers an overview of collections at NACDA. Using our metadata tools and variable search database, NACDA can identify studies in its collections that examine aspects of aging and health among adults during their lifecourse. Many of the studies are longitudinal or repeat measure cross-sectional studies. We are also able to identify studies which focus on aging that are not maintained by NACDA but which are available to interested researchers. Using a strategy of archival preservation combined with a strong focus on productive research and outreach, NACDA has amassed data and metadata covering a wide array of studies worldwide that address the aging lifecourse. Because our collections are multinational, we share these data at no cost to interested users worldwide


In the original article, there was an error. The statement of the written informed consent procedures was incorrect because of inappropriate wording.Materials and Methods, subsection Subjects, paragraph two:A correction has been made to the “This study was approved by the Ethical Committee of Tianjin Medical University General Hospital and written informed consent was obtained from all subjects or their guardians.”The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Concerns have been raised that the transplants performed in the local context at the time of procedures reported in this article  may haveDetails as to the donor sources and methods of obtaining informed consent from donors were not reported in , and wheThe authors state that no vulnerable populations were involved in their research and all organs were obtained with informed consent but did not provide ethics approval documentation to support their claim or clarify whether organs had been procured from prisoners.The authors did not respond to inquiries about the availability of underlying data supporting this study.PLOS ONE Editors retract this article.Owing to the lack of documentation to demonstrate this study had prospective ethical approval, insufficient reporting, unresolved concerns around the source of transplanted organs and whether they included organs from prisoners, and in compliance with international ethical standards for organ/tissue donation and transplantation, the The corresponding author notified the journal that all authors disagree with the retraction. The other authors either could not be reached or did not respond directly.


There has been a long tradition of wayfinding and orienteering studies in humans but these have mostly neglected possible age-related differences in navigation. This field of inquiry is experiencing something of a resurgence of interest due to the development of VR technology which has brought the systematic study of large scale navigation into the laboratory and into the MRI scanning environment. Empirical studies to date identify navigation as an aspect of cognition that is vulnerable to the aging process. Functional and structural neuroimaging studies in humans suggest that age-related changes in the brain’s “navigation circuit” may underlie these behavioral age differences. Older adults also adopt unique spatial strategies and knowledge of these strategy preferences could enlighten both basic science research in spatial cognition and also inform the development of age-specific technological assistance that may extend functional independence of older adults into later life.


This study investigated whether perceived neighborhood quality was associated with chronic loneliness for adults 60 and older in the United States. Although loneliness can be episodic and overcome, chronic loneliness has been identified as a social determinant of health. Utilizing ecological systems theory we hypothesized that higher levels of neighborhood social cohesiveness would be associated with lower odds of chronic loneliness. We postulated that the networks available to people in the proximal area where they live could provide social opportunities for reducing loneliness. This idea was consistent with prior findings indicating the salience of neighborhoods for retirees, but inconsistent with research indicating the importance of a confidant in reducing loneliness. Data from the 2008 and 2012 Health and Retirement Study Psychosocial Surveys were used (n = 3530). Loneliness was measured using the 3-item scale developed by Hughes and colleagues in 2004. Findings from unadjusted logistic regression indicated that loneliness was inversely related to neighborhood cohesion as measured by an index of the trustworthiness, friendliness and helpfulness of neighbors and cleanliness, occupancy, lack of graffiti, and sense of belonging in the area . When demographic and health-related factors were entered into the model the odds of being lonely were significantly lower for those with higher ratings of social cohesion . These findings were consistent with the idea that neighborhoods are an important social place for older persons and interventions at the neighborhood level may be more effective than individualized treatment plans.


Systematic reviews of clinical trials aim to include all relevant studies conducted on a particular topic and to provide an unbiased summary of their results, producing the best evidence about the benefits and harms of medical treatments. Relevant studies, however, may not provide the results for all measured outcomes or may selectively report only some of the analyses undertaken, leading to unnecessary waste in the production and reporting of research, and potentially biasing the conclusions to systematic reviews. In this article, Kirkham and colleagues provide a methodological approach, with an example of how to identify missing outcome data and how to assess and adjust for outcome reporting bias in systematic reviews. Bias arises when trialists select outcome results for publication based on knowledge of the results. Hutton and Williamson first defined outcome reporting bias (sometimes termed selective reporting bias) in 2000: “the selection on the basis of the results of a subset of the original variables recorded for inclusion in a publication.”of systematic reviews.Empirical research provides strong evidence that outcomes that are statistically significant have higher odds of being fully reported than non-significant outcomes (odds ratios ranging from 2.2 to 4.7).The aim of this article is to show, with an example, how systematic reviewers can minimise the amount of missing data in reviews of healthcare interventions, and use ORBIT methods to detect and classify the suspicion of outcome reporting bias in benefits and harms reported in included studies. The paper also provides details of a statistical approach to assess the robustness of meta-analysis conclusions on this potential source of bias that non-methodologists can implement on a web based platform.Outcome reporting bias occurs when trialists select for publication a subset of the original recorded outcomes based on knowledge of the results. Outcome reporting bias is a threat to evidence based medicine and contributes to waste in researchEmpirical evidence suggests that statistically significant outcomes have higher odds of being fully reported than non-significant outcomes (odds ratios ranging from 2.2 to 4.7)The ORBIT  research programme offers tools for systematic reviewers to identify missing outcome data, and assess and adjust for outcome reporting bias. A tutorial is provided to show how these tools could be used in a systematic reviewOne way to streamline the process of systematic reviews and to help reduce outcome reporting bias is for reviewers to use outcomes considered as core for all trials in a particular topic area.We recommend that systematic reviewers consider core outcome sets when registering their topics with Cochrane review groups or PROSPERO . Systematic reviewers can identify if relevant core outcome sets exist for their review area by searching the publically accessible COMET  database.Reviewers should not exclude studies from their review on the basis of whether the outcomes of interest were reported, because non-reporting does not necessarily mean that the outcomes were not measured.We strongly encourage systematic reviewers to include relevant studies in their review irrespective of whether the studies reported any of the review outcomes of interest, and to assess those studies in accordance with the methods described below.An outcome matrix was proposed to help identify missing study outcome data.For trials that do not or partially report on outcomes, the matrix allows reviewers to assess the risk of outcome reporting bias according to the ORBIT classification system (see next section below). In the epilepsy example in We strongly encourage systematic reviewers to include an outcome matrix in their reviews. The ORBIT matrix generator, available on the ORBIT website,Sources for obtaining unpublished information on clinical trials for use in systematic reviews have previously been described.When no usable missing outcome data can be obtained from the sources given above, the ORBIT researchers developed classification systems to help systematic reviewers detect outcome reporting bias in reviews. The method relies only on information in the published trial report , expert clinical judgment, and an assessment of the outcomes that researchers usually report across a set of trials in a review.For the epilepsy review, the classifications given for each outcome with missing or partially reported data are presented in the outcome matrix , with a To assess the risk of bias due to selective reporting, we recommend that the ORBIT classification system is used by systematic reviewers as a framework to determine whether there is a high or low risk of outcome reporting bias when review outcome data are missing or partially reported. We also recommend that the assessment is completed by at least two independent researchers and differences discussed to agree on an overall classification .Copas and colleagues developed new statistical sensitivity approaches for assessing the robustness of review meta-analysis conclusions when outcome reporting bias is suspected.We return to our epilepsy example given earlier, for which the outcome matrix of the ORBIT classification is shown in After applying the Copas bias adjustments for partially reported or unreported outcomes , the revWhen outcome reporting bias is suspected, we recommend that the quality of evidence is lowered in relation to the standard GRADE  assessment applied in reviews. We also recommend that sensitivity analyses are performed for important outcomes to assess the robustness of conclusions to outcome reporting bias.Empirical evidence suggests that outcome reporting bias is a threat to the validity of the evidence base and contributes to research waste. We have highlighted up-to-date approaches and recommendations for detecting this problem and adjusting the results when performing sensitivity analyses in systematic reviews. We anticipate continued application of these methods and methodological research into the assessment and adjustment of outcome reporting bias in the years to come. The ORBIT website is a useful resource, providing researchers with tools to detect outcome reporting bias and methods for sensitivity analysis; it is also a repository for important publications in this field.


Aging is the product of numerous dynamic processes that span multiple domains of functioning , multiple levels of analysis, and multiple time-scales. Scientific inquiry in many fields has benefited from articulation and analysis of complex systems. This symposium brings together a collection of papers that illustrate how dynamical systems modeling is contributing to both theory and understanding of aging. Yang and colleagues apply Boolean network approach to intensive longitudinal data to identify sequences of emotion and behavior that lead to a stable equilibrium, and suggest how that information can be used to design interventions that push individuals toward a healthier equilibrium. Rector and colleagues illustrate use of dynamic indicators and multiscale entropy measures as indicators of resilience and explain how those measures may be used in prediction of physical recovery. Brick highlights how sequence mining methods can be used to identify commonalities and differences in dynamic change, and how those patterns characterize and distinguish groups with respect to aging trajectories. Moulder and colleagues demonstrate how latent maximum Lyapunov exponents can be used to study sensitivity of individuals’ developmental trajectories to initial conditions. Boker and colleagues provide a general overview of how dynamic models, including an adaptive equilibrium regulation model, distinguish resilience to acute versus chronic stressors and patterns of regulation. Together these papers highlight the value complex system thinking can add to our understanding and optimization of aging.


Following publication of this work , questioThe Ethics Committee at Ghent University have clarified that authors received specific approval for this study. The published ethics statement was incomplete, however, and is hereby corrected to the following:Patients consulting at the department of orthopaedics and traumatology are asked to sign a generic informed consent giving permission to use their medical data for retrospective research purposes  of patients who needed meniscal surgery in the past. All data were generated from the patient files and put anonymously in a dataset (used for this manuscript). Only the data from the patients with meniscal allograft transplant surgery were collected out of the general database (B670201317873) and added to the dataset (used for this manuscript).


The successful results of the program have led domestic and foreign governments to consider the application of cap and trade to address other air quality issues. Certain analyses are particularly important in determining whether or not cap and trade is an appropriate policy tool. This paper offers a set of questions that can be used as criteria for determining whether or not cap and trade is the preferred policy approach to an environmental problem.The use of emissions trading (cap and trade) is gaining worldwide recognition as an extremely effective policy tool. The U.S. Sulfur Dioxide (SO


The data presented in this research show the results of the experimental study of acoustic behaviour of coconut fibre-reinforced concrete (CFRC). The CFRC was added in percentages of 0.25%, 0.5%, 0.75% and 1% of cement. The acoustic test was conducted to determine the amount of sound that can be absorbed by the fibre. The data showed that the concrete reinforced with coconut fibre had the highest sound absorptive power, of which fibre treated absorbed more sound than other fibres, this is because washing of fibre increase the lignin content which is responsible for the sound absorbing property. The data also showed that the curing time had no effect on the absorbing property of the CFRC. The data presented will be useful in the construction of sound proof reinforced concrete slabs, walls and other elements. Specifications tableValue of the data•These data will be useful to researchers working on incorporating coconut fibre on concrete.•The data presented show that incorporating fibre in concrete improved the slump because the fibre absorbed some of the water during mixing.•The data are valuable because they show that coconut fibre absorbed some amount of sound. Also, distance of propagation should be considered in further studies.•The data obtained in this study solve the issue of noise affecting the occupants of buildings located in urban and rural areas.•The data presented in this study provide an affordable and functional replacement for sound proof materials as opposed to importing of sound absorbing materials.1Composite material is defined as a unique combination of the fibre and the concrete matrix where function of the fibre is to withstand load and make the composite stiffer meanwhile matrix is a binder which holds the fibre in place 2Portland cement of the Dangote brand in conformity with


Trust and reciprocity are cornerstones of human nature, both at the levels of close interpersonal relationships and economic/societal structures. Being able to both place trust in others and decide whether to reciprocate trust placed in us is rooted in implicit and explicit processes that guide expectations of others, help reduce social uncertainty, and build relationships. This review will highlight neurobehavioral mechanisms supporting trust and reciprocity, through the lens of implicit and explicit social appraisal and learning processes. Significant consideration will be given to the neural underpinnings of these implicit and explicit processes, and special focus will center on the underlying neurocomputational mechanisms facilitating the integration of implicit and explicit signals supporting trust and reciprocity. Finally, this review will conclude with a discussion of how we can leverage findings regarding the neurobehavioral mechanisms supporting trust and reciprocity to better inform our understanding of mental health disorders characterized by social dysfunction. Racial bias can be particularly pervasive: an individual’s implicit bias  relative to the bottom line outcome —may be particularly diagnostic when deciding whether to trust a partner  differential weighting of reciprocity (or defection) as a function of the strength and valence of an initial impression of a partner; and (2) for initial impressions and experienced outcomes to influence each other in order to learn about a partner. In other words, whether a partner reciprocates or violates trust informs the updating of an impression, which then feeds forward to differentially weight subsequent instances of reciprocity/violation of trust  in ways that are consistent with prior impressions of others as “good” or “bad”: reciprocity from someone initially perceived as trustworthy contributes more heavily to subsequent choices to a violation of trust from that same partner, and vice versa  based on whether we have priors about their tendency to cooperate , which may be quantified as the trade-off in value between outcomes for the self vs. outcomes for others  the monetary amount that a trustee thinks that an investor would expect them to send back ; and (2) the amount that the trustee actually sends back. This difference is weighted by a guilt aversion parameter which indexes sensitivity to feeling guilt , which may underlie the propensity for re-victimization in this population  involved in trust and reciprocity, our understanding of neural and behavioral mechanisms of trust and reciprocity will be bolstered by integration with advanced neuroimaging approaches. Recent efforts linking individual differences in computational strategies supporting reciprocity  with differential patterns of brain activity assessed by inter-subject representational similarity analysis (van Baar et al., DF wrote the manuscript.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The goal of this study was to leverage data from two environmental regulatory initiatives, Ontario’s Toxics Reduction Act (TRA) and Canada’s National Pollutant Release Inventory (NPRI), to assess their ability to monitor trends in the use and emission of carcinogens by industry sector in Ontario.Data reported to the TRA and NPRI by industrial facilities in Ontario were retrieved from 2011 to 2015. Twenty-six known and suspected carcinogens were identified (IARC) and the trends in the use and emission were evaluated by industry sector. The locations of industrial facilities that used and released carcinogens were mapped by Public Health Unit (PHU).Chemical manufacturing and primary metal manufacturing sectors accounted for 84% of all reported industrial use of carcinogens during the period 2011–2015. The largest source of carcinogen emissions came from facilities in the primary metal manufacturing and paper manufacturing sectors. The largest number of industrial facilities that reported the use and release of carcinogens were located in the City of Toronto and Peel Region PHUs. Overall, the use of carcinogens across all sectors appeared to decrease by 8%, while emissions increased by about 2%.The results of this study show the need to reduce the use and emission of select carcinogens in priority industry sectors. Environmental reporting programs, such as the TRA and NPRI, can serve as important tools in cancer prevention by tracking potential carcinogen exposures in the environment and in the workplace. About one out of every two Canadians will be diagnosed with cancer in their lifetime  , particulate matter less than 10 μm (PM10), and total particulate matter, only releases of PM10 were selected for analysis in this study as they were reported more frequently. IARC has classified all particulate matter as a known human carcinogen  Industrial facilities in Ontario that report their releases to the NPRI must report their use of toxic substances to the MOECC’s TRA program from a list of substances prescribed by the program. Of the 322 substances prescribed under the TRA, those classified as known human carcinogens (group 1) and probable human carcinogens (group 2A) by the International Agency for Research on Cancer (IARC) were selected for analysis in this study , in order to geographically analyze the data for industrial facilities in both datasets. There are 36 PHUs in all of Ontario  by its intercept and multiplying by 100%. The same method was used to calculate trends for releases. All data analyses were performed using the statistical software SAS 9.4 .The total estimated use and release of carcinogens by industrial sector summed for all years from 2011 to 2015, the mean number of employees for each sector and the top three known and suspected carcinogens by amount used and released are shown in Table Facilities in the chemical manufacturing sector ranked first among all sectors for reported carcinogen use, using more than 10 million t in the 5-year period analyzed  and the transportation equipment manufacturing sector   located in the City of Toronto PHU, followed by Peel Region PHU (n = 51)  and Sudbury and District Health Unit (n = 2650 t), respectively (data not shown). The chemical manufacturing and petroleum and coal product manufacturing sectors are prominent industries in Lambton Health Unit and were likely responsible for the carcinogen use observed in that PHU. In Sudbury, nickel mining remains an important industry contributing to the large quantity of carcinogenic emissions.Of the 326 industrial facilities reporting the use of carcinogens in 2015, the City of Toronto PHU and Peel Region PHU contained the largest number of industrial facilities that reported the use of carcinogens, with each containing 34 facilities . A more detailed analysis of use and emission trends by carcinogen were previously discussed (Slavik et al. In addition to analyzing carcinogen use and emission by industry sector, this study examined the distribution of industrial facilities by PHU to explore potential geographic patterns in industrial sites. The largest number of industrial facilities reporting the use and release of carcinogens were observed in the city of Toronto, Ontario’s most populous city. This finding is consistent with previous research that identified significant sources of industrial pollution in Toronto, where neighbourhoods with higher emissions of toxic contaminants were also characterized by populations who were racialized or socio-economically disadvantaged (Kershaw et al. Lung carcinogens are among the most used in industrial facilities in Ontario (Slavik et al. One limitation of this study is that the amount of toxic substances used and emitted by facilities is self-reported in both the NPRI and the TRA, though some consistency between volumes of self-reported pollutant releases by industrial facilities and pollution monitoring data have previously been found (De Marchi and Hamilton In addition, there are limitations in the reporting requirements of the TRA program for toxic substance use. The program allows for the reporting of use quantities by industrial facilities as ranges as opposed to absolute quantities, which limits the analysis to estimates. Another limitation of most environmental reporting programs is the fact that only larger industrial facilities meeting specific use and release thresholds are required to report (Dolinoy and Miranda There are also limitations in applying carcinogen use and release as indicators of potential exposure since numerous other factors impact a worker’s exposure to chemicals. These other factors, including exposure controls such as safe work practices and personal protective equipment, were not examined in this study. It should also be noted that high sector emissions do not necessarily equate to high cancer risk since contaminants are dispersed and are often transported across large distances in the environment (Li and Ma Databases like the TRA and NPRI can be used for surveillance to provide estimates of industrial carcinogen use and release when detailed exposure assessments and routine environmental monitoring are not feasible. A major strength of the approach used in this study is the combination of descriptive and quantitative approaches to assess industrial trends in the province by both characterizing potential exposures in sectors of concern and quantifying changes in carcinogen use and release. The methods are also highly transferable to other jurisdictions where similar environmental reporting databases exist and concerns over toxics use and emission are present.There remain opportunities to reduce the use and release of carcinogens in many Ontario industries. The TRA program is still in its infancy and future analyses drawing from more datasets will be able to better indicate longer-term trends in carcinogen use and release. The findings from this study may inform future efforts to quantify levels of exposures in particular industry sectors or geographic regions where those industries are present. While this study does not attempt to draw conclusions on the risk of developing cancer in workers and populations residing near certain industries, it demonstrates the need to prioritize exposure prevention strategies in particular sectors where the most carcinogens are used and emitted.


The published article  containsPatients attending Kasr Al Ainy hospital sign a consent form at admission to agree to use of their clinical data for research. The authors were involved in patients' care and management during their clinical course, but data were de-identified when extracted from the clinical database for use in this study. The Cairo University Research Ethics Committee confirmed that this study was exempt from the requirement for approval. As per the University’s regulations, retrospective data analysis and other research that does not include interactions with or collection of identifying personal data from living human subjects, is exempt from Research Ethics Committee continuous review.


AARP will introduce research on rural residents from the 2018 Home and Community Preferences Survey of Adults Age 18 and Older that shows the importance of making communities places where rural residents can successfully age throughout all stages of life. This data will provide useful insights regarding what adults who live in rural areas want and need in their communities to positively contribute to their overall health and well-being and keep them actively engaged and involved in their community. The survey data can serve as a key tool for communities to understand what rural residents view as important for successfully aging in place and strategies that communities might employ to create community supports and services conducive for older rural residents.


Home- and Community-Based Services (HCBS) are increasingly important for older adults who want to maintain their independence and remain in their communities. Although HCBS systems have been developed widely in many western countries and in some countries in Asia, China is just beginning to grapple with its rapidly aging population by offering HCBS in a limited fashion. The purpose of this study was to investigate the relationship between structural  and cognitive  social capital and HCBS utilization among older Chinese adults. The study also examined the mediating effect of structural social capital for the the relationship between cognitive social capital and HCBS utilization. We frame the study within the Andersen behavioral model of health services utilization and argue that within this framework social capital is an enabling factor. We analyzed survey data from 456 community-dwelling older adults living in the Gusu district of the city of Suzhou, China in 2015. Structural equation modeling was used to test the hypothesized relationships. The results showed that both cognitive and structural social capital were significantly associated with HCBS utilization. Structural social capital also served as a mediator between cognitive social capital and HCBS utilization, even after controlling for sociodemographic characteristics and other relevant covariates. The findings supported the utility of employing Andersen’s behavioral model and social capital theory for better understanding older Chinese adults’ utilization of HCBS. Interventions for increasing social capital may be useful for improving HCBS utilization in Chinese urban communities.


Diagnostic imaging pathways are developed to ensure that medical imaging examinations are appropriately selected and referred by clinicians with the aim of justifying the use of imaging modalities for clinical diagnosis. Failing to comply with the imaging pathways or guidelines results in exposing patients to unnecessary ionising radiation due to malpractice of imaging referrals. This editorial provides a comment on a recent study reporting very high percentage of general x‐ray imaging referrals which did not or partially met the imaging pathways in an emergency department. Advances in medical imaging technologies over the past number of decades have resulted in an increase in the sensitivity and specificity of imaging examinations, thereby improving diagnostic accuracy and the opportunity to deliver more accurate and personalised care. Parallel to these improvements, defensive medicineIn Australia, the Western Australia (WA) Government has developed the Diagnostic Imaging Pathways, which provide evidence‐based medicine to guide health professionals in the judicious use of imaging modalities for diagnosis of various pathologies. This presents the most appropriate diagnostic examinations in a desirable sequence for a wide range of clinical scenarios.Journal of Medical Radiation Sciences, Rawle and PighillsP < 0.001).In the current issue of the Similarly, a review of 140 medical records which did not meet the pathway or were unclear , a high percentage of medical records (65.5%) did not meet the imaging pathway criteria. Further analysis of the data was performed by combining these imaging referrals with medical records, and their results showed improvement with unjustified examinations reduced to 49%. Results of this study indicate that an excessive high percentage of clinically unjustified x‐ray imaging examinations were performed in the emergency department. They concluded that referring clinicians were not providing adequate relevant information and that the radiographers were not complying with justification requirements.There are several aspects from Rawle and Pighills’ studyThe WA pathways are intended to help medical practice by improving the efficiency of health service delivery and promoting fair and cost‐effective care; however, its use as a reference brings some limitations. As individual patient circumstances vary, each pathway is neither a rigid set of rules nor a substitute for clinical assessment. It is also acknowledged that diagnostic practice may vary from one healthcare provider to another. Other variables include local availability of equipment and available expertise as previously stated. The 173 individual scenarios available cannot cover all possible patient presentations and for that reason, a divergence from the proposed pathway may be acceptable in certain circumstances.Another important issue to consider is the lack of research to identify the reasons behind whether it is due to the quality or absence of provided training or is a result of the availability of equipment and expertise in the fields that were explored or the communication between all individuals involved. The information provided to patients and the consent obtained from them to perform an examination may also influence the ultimate approach to diagnosing the patient's condition.In summary, one strategy that can be considered to reduce the number of unjustified examinations being performed is to develop criteria that are adapted to each context to guide the respective clinical community and to simultaneously introduce high quality education and training sessions across healthcare departments. The aim of these sessions would be to improve knowledge of radiation exposure in medical imaging, associated risks and appropriate examinations available for main pathological conditions based on clinical audits.


This opinion article highlights the importance of targeting critical brain regions during reconsolidation to gain insight into the brain mechanisms of memory dynamics and modulating existing memories.Accumulating evidence has shown that reactivated existing memories become sensitive to modification during reconsolidation   have a role in modulating plasticity (Nitsche et al., Since NIBS techniques are promising interventions for treating declarative memory impairments that are often the first symptoms of dementia, the combination of NIBS with pharmacological interventions could prove to be an important symptomatic therapy for subjects with MCI due to AD (Albert et al., Finally, future research should address the issue of inter-individual variability in the effects of NIBS during reconsolidation. In particular, the possibility that variations in the presence of specific genetic polymorphisms (e.g., brain-derived neurotrophic factor gene; Chaieb et al., In conclusion, a better understanding of these basic and clinical issues will be instrumental to the development of NIBS clinical interventions for improving memory and symptoms through reconsolidation.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The re-emergence of Zika virus in Brazil and other contiguous countries is a source of anxiety for pregnant women on account of its association with microcephaly. Adverse pregnancy outcome has huge mental health implications. It is essential for health providers to incorporate psychosocial care as part of pre and postnatal care for women in all countries affected by the Zika virus infection. The resurgence of Zika virus in Brazil and the dire medical implications for the populace and pregnant women, in particular, led to its declaration as a public health emergency in November 2015 . SusceptThe WHO and the Brazilian health authorities must be commended for recognizing and declaring the Zika virus outbreak a public health emergency and forming a multidisciplinary committee but so much needs to be done and lessons drawn from the recent Ebola outbreak. Ultimately, all-inclusive health systems approach that combines flexibility with effectiveness is needed to achieve the health objectives. A three-pronged approach is recommended:Strengthening of the health facilities in Brazil and other neighboring countries on emergency preparedness and proactive handling of the Zika virus through adequate testing, surveillance and case management: There should be an aggressive contact tracing and provision of requisite equipment for laboratory testing and diagnosis of all suspected cases of Zika Virus. Psychosocial support is very essential and the long term effects of anxiety and trauma (post-traumatic stress disorder (PTSD) must be expected in the women that lost their pregnancy or babies during the outbreak. Psychotherapy for pregnant women and families affected is essential. Clinical psychologist and psychiatrist should be included in the high-level team set up by affected countries to address the health challenges. The WHO guideline on the provision of psychosocial support for women and families affected by Zika virus [ka virus  should bCommunity engagement and participation by all stakeholders: Productive dialogue and information channels must be created to serve as a two-way information link between the communities, women the health authorities. Community engagement would foster understanding and dispel the atmosphere of misinformation and fear that subsist in similar epidemics [pidemics . AggressAdequate prevention and Vaccine development of a vaccine is essential: The proactive prevention guidelines set up by the Public Health England (PHE) and the Royal College of Obstetrics and Gynaecology is recommended for health care providers everywhere [erywhere . Zika vierywhere -11. Timeerywhere .Zika virus is major public health issue with implications for women of reproductive age. From the health systems perspective, it is important to adequately allocate resources, build capacity, and develop appropriate clinical protocols for the healthcare workforce for diagnosis and treatment. Emergency response preparedness in virus outbreaks is glaringly sub-optimal and the mental health needs of affected individuals must be made a priority.


Despite a global consensus that nurses and midwives constitute the majority and are a backbone of any country’s health workforce system, productive capacity of training institutions remains low and still needs more guidance. This study aimed at developing a middle-range model to guide efforts in nursing education improvements.To explore challenges facing nursing education in Malawi and to describe efforts that are being put in place to improve nursing education and the process of development of a model to improve nursing education in Malawi.The study used a qualitative descriptive design. A panel discussion with eight nursing education and practice experts was conducted guided by core concepts derived from an analysis of research report from a national nursing education conference. Two focus group discussions during two quarterly review meetings engaged nurse educators, practitioners and clinical preceptors to fill gaps from data obtained from a panel discussion. A qualitative abductive analysis approach was used for the development of the model.Transforming and scaling up of nursing education emerged as the main concept of the model with nursing education context, academic practice partnership, regulation, competent graduate and nursing workforce as sub concepts. Key main strategies in the model included curriculum reforms, regulation, transformative learning, provision of infrastructure and resources and capacity building.The model can be used to prioritise nursing education intervention aimed at improving quality of nursing education in Malawi and other similar settings. Malawi is among countries with the most strained health systems in sub-Saharan Africa characterised by a heavy burden of disease  , nurse educators (n = 12), nursing managers (n = 8) and nursing clinical preceptors (n = 8) from teaching hospitals who participated in two NEPI quarterly review meetings. Theoretical sampling shaped further data collection as the researcher pursued developing conceptual ideas and participants helped to clarify understanding  for nurse educators to share best practices in enhancing nursing education in Malawi . During Data from the study were analysed based on grounded theory approach  and the Malawi National Health Research Ethics Committee (NHSRC 1154). Permission was sought from NEPI project manager to conduct quarterly review sessions for data collection. Informed consent was obtained and participants voluntarily took part in the study. No data were linked to individual participants to ensure anonymity. Data were treated with confidentiality.Four core concepts emerged from an analysis of research reports that were presented at the national nursing education conference. These were nursing education context, academic–practice collaboration, competent graduate and transformative strategies .These core concepts formed the basis for a panel discussion and subsequent focus group discussions with nurse educators, practitioners and clinical preceptors, which resulted in the emergence of five themes.Participants of both the panel discussion and focus group discussions highlighted the need to have curricula that respond to the healthcare users. Findings show that there is a mismatch between the type of nurses and the expectations of the service users. Some participants reported that:‘we still train a lot of nursing midwifery technicians than registered nurses and midwives. That’s an issue of quality of nurses.’ ‘the country should target having registered nurses who are primary health care oriented because most users access health services at this level.’ Participants noted that curricula should be formulated in accordance with the actual health needs of the users.Participants reported:‘Our country needs nurses and midwives who are deliberately trained for the rural areas. Nurses who will serve the neglected communities.’ ‘as a country we have not embraced interprofessional training of health workers yet. We need training programs that will foster inter-professional approach to healthcare problems and demands.’ Findings have shown that nursing education contributes substantially to the reduction of the healthcare workforce shortage. Some extracts from panel discussion include:‘our nursing programs no longer produce nurses whom the healthcare delivery system could rely on to deal with the challenges among our communities.’ ‘… there are too few nurses to serve the increasing number of patients in the health centres and health posts in remote areas.’ ‘… the HSSP drives the agenda for all of us, be it education, practice or regulation.’ Findings of the study show that there is a well-established system of regulation and accreditation of nursing education in Malawi. The nurses and midwives council ensures that all nursing programmes being offered in the country are approved and accredited. Participants urged therefore that the nurses and midwives council should therefore be well conversant with the nursing care needs of the service users. Participants highlighted the importance of strategic leadership with the regulatory body in order to increase the number of competent nurses and midwives.Participants highlighted that:‘nurses and midwives council prescribes curricula content for nursing programs. It should be well informed of the healthcare needs in order to provide relevant nursing curricula.’ Participants also noted that the nurses and midwives council regulates licensure of nursing personnel.‘nurses and midwives write licensure examination before they can practice in this country. How come then we talk about poor quality of nurses when they have been evaluated whether fit or not to practice.’ ‘we need to rethink how we want to regulate licensure systems for our nurses and midwives.’ Participants highlighted that national standards of nursing education are key to ensure quality health services.‘… various nurses and midwives council standards help to keep nurse education in Malawi in good order.’ ‘… a joint evaluation exercise should be done with the Nurses Council to assess if programs have been formulated according to the needs of the national health system.’ Findings of the study indicate that there is a growing number of students being enrolled in the training institutions. All participants concurred that there is overcrowding of students in the clinical area and this challenges clinical teaching of students. Some participants indicated:‘teaching students in classroom and clinical practice is a challenge now with increased student intakes. We need to find better ways of teaching these students.’ ‘… individualized teaching is more important now than ever. You need to ensure that each student’s learning needs are met if you are to ensure quality students.’ Findings of the study show that need for more space, infrastructure and resources cannot be ignored owing to the increasing number of students. Infrastructure and resources to support transformative methods are needed at both educational and practice institutions. Participants noted that in the absence of adequate infrastructure, distance learning is becoming an option in many countries to avert challenges with space owing to increasing number of students. Participants highlighted that:‘… massive investment is needed to provide educational institutions with adequate infrastructure and resources in order to accommodate changing number of students and need for innovative way of teaching them.’ ‘… we have increased the nursing intakes to the extent that we cannot accommodate or trace them in the clinical sites.’ Participants of the study reported that there are problems with capacity among nursing faculty in terms of clinical competences. Participants noted that over time, faculty members lose their practice competences. Findings show that there should be deliberate continuous professional development for nurse educators. Participants highlighted that improving educational capacity through nursing faculty development could be one of the several strategies to address a complex human resource problem. Participants reported that:‘There should be deliberate effort to equip educational institutions with capacity to handle growing number of students and more importantly changing health care landscape.’ ‘… mutual collaboration among academic and practice staff increases their chance to share expertise thereby building each other’s capacity.’ Chinn and Jacobs  highlighThe model for improving quality, quantity and relevance of nursing education was created on assumptions derived from World Health Organization framework for transforming and scaling up health professionals’ education and training (World Health Organization Transforming and up-scaling of nursing education should be responsive to the health needs of societies and ensure universal coverage.Teaching and learning process should prepare a graduate who is ready to address the health system’s needs and demands.National, institutional and programme leadership commitment drives positive transformation when implemented using a collaborative and partnership approach.A nurse graduate who is competent, relevant to the needs of a society, builds a strong health system.The middle-range model presented in this article is aimed at guiding efforts to improve quality, quantity and relevance of nursing education in Malawi. This is a planning model and aims at providing guidance to planners to match strategies with situational determinants within the nursing education context. Planning models are developed to prevent the common practice of using one strategy to solve all problems. Although the model was developed in the Malawian context and within nursing education, it can be used in any country with similar nursing education context and in a variety of health professionals’ education.Chinn and Kramer  stated tTransformative and scale-up of nursing education refers to a sustainable expansion and reform to increase quantity, quality and relevance of health professionals (World Health Organization Curriculum reform is central to transform the quality and relevance of nursing education. The recent focus on competency-based curriculum calls for identification of critical nursing activities and general competencies (Ten Cate & Scheele Interprofessional education has been recognised worldwide as a key component in strengthening healthcare and overcoming practice challenges by teaching students the necessary skills to become part of the collaborative practice-ready health workforce (Thistlethwaite & Moran Regulation is one important strategic direction in the roadmap for scaling up health workforce. The function of regulation is to ensure that each individual has some level of understanding of accountability to his or her professional discipline. Regulation can be enforced at different levels. Institutions can be regulated through accreditation to ensure they meet expected standards to train nurses or for student practice in case of clinical institutions. Individuals are also regulated to ensure that they possess the relevant competences to be safe practitioners. Quality assurance in nursing is important for healthcare services users’ safety. The regional professional regulatory framework for nursing and midwifery reported that efforts to improve nursing and midwifery tend to ignore regulation (World Health Organization With the growing number of students being recruited into nursing programmes, there should be innovations in methods of teaching and learning. In common instances, despite the growing number of students, the number of clinical practice sites have remained the same (Msiska, Smith & Fawcett Infrastructure and resources to support transformative methods are needed at both educational and practice institutions. In the absence of adequate infrastructure, distance learning is becoming an option in many countries to avert challenges with space owing to the increasing number of students Graber .Capacity building as a sub-concept spurs around three dimensions. Firstly, studies have reported that the productive capacity of training institutions in many sub-Saharan countries is low. Training institutions cannot recruit adequate number of students. Appiagyei et al.  highlighMandatory continuous professional development is needed for faculty (Breakey et al. Nursing education context in this model refers to the present situation in the country serving as an antecedent for developing a model that will enhance nursing education in the country in terms of quantity, quality and relevance.Malawi like many other sub-Saharan African countries still reports poor health indicators. Several factors have been attributed to the situation including inadequate financing of the health systems (Lu et al. The structure of the model shows that the need for transformation should overlap within all levels of strategic implementation. Transformation needs to take place at national, institutional and programme levels guided by policy and frameworks that define national agenda for health. The national health needs are central and provide policy direction.Political agenda and strategic direction refer to governments’ and nursing education stakeholders’ plans with regard to nursing education improvement, expansion or reforms. Malawi is a United Nations member state and it abides by conversations and protocols set by United Nations through its agencies to improve the well-being of humanity. The political agenda and strategic direction is propagated down the system from national, institutional to programme levels. The National Health Sector Strategic Plan 2011–2016 highlighted the importance of transforming nursing education. The main goal of the Government of Malawi is to have the highest possible level of health and quality of life for all Malawians. Institutions and programmes have to set their agenda to be responsive to the national goal. Lu et al.  noted thNational health policies, strategies and plans play an essential role in defining a country’s vision, priorities, budgetary decisions and course of action for improving and maintaining the health of its people (Dahlgren & Whitehead Partnership refers to a deliberate arrangement between parties to cooperate to advance mutual interest. In this model, academic practice partnership is defined as a well-defined strategic relationship between educational and clinical practice settings in the area of practice, education and research. Student nurses generally rotate between blocks of theory and clinical practice. The model advocates for formal structured relationships towards achieving the country’s health sector objective of health for all. The model is also built on the assumption that a health system consists of all organisations, people and actions whose primary interest is to promote health, in which collaboration is critical (World Health Organization The complexity of the healthcare environment demands collaboration between academia and practice setting in preparing an effective healthcare workforce (Frenk et al. Competency refers to the expected level of performance integrating knowledge, skills and attitudes. In the model, a competent graduate is one who demonstrates the ability to perform based on this expected level after training. Kajander-Unkuri et al.  identifiThe nature of the curricula and amount of time students engage in putting theory into practice determine competence levels of students (Rahmati et al. The poor rural communities are most often neglected (De Kock & Pillay Nursing workforce in this model refers to a system of qualified and licensed nurses that form part of the healthcare workforce. Malawi has nurse midwife technician and registered nurse cadres. Enrolled nurses are trained to a minimum of college diploma while registered nurses are trained from the level of university diploma or higher.Healthcare workforce is a key building block of health systems Essack . It affeThe model was evaluated in accordance with the criteria proposed by Fawcett  for modeThe study was conducted to guide implementation and evaluation of transformative and scale-up of nursing education in the local context of Malawi. Guidelines provided by key stakeholders like the World Health Organization remain relevant to the implementation of the model.For nursing education – The model has been developed to guide implementation and evaluation of strategies to improve the quality, quantity and relevance of nursing education.For research – More research is needed to explore the impact of specific strategies using the model through comparative studies between Malawi and other countries with a similar context.The design and assumptions of the model were discussed followed by a description of concepts and relationship among concepts. Nursing education transformation and scale-up should take place within a collaborative environment that fosters mutual strategic and operational planning within the framework of willing and committed leadership. Leadership cuts across approaches at national, institutional and programme levels among all nursing education stakeholders.


Recently, Noorani  suggesteNoorani  opinion With these models in mind, some aspects of Noorani  opinion TIMER-RIDER model has several advantages. It explains normal and pathological behaviors in paradigms in which movement cancellation is required or not . The modThe author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Any density gradient for the isolation of nonmammalian organelles should ideally only expose the sedimenting biological particles to an increasing concentration of the gradient solute. Thus they will experience only an increasing density and viscosity, other parameters such as osmolality, pH, ionic strength and the concentration of important additives (such as EDTA and DTT) should remain as close to constant as possible. This Protocol Article describes the strategies for the dilution of OptiPrep™ in order to prepare such solutions for organelles and membranes from nonmammalian sources such as yeast.