Case report: Long-term follow-up of patients who received a FimCH vaccine for prevention of recurrent urinary tract infections caused by antibiotic resistant Enterobacteriaceae: a case report series.

Urinary tract infections (UTI) caused by carbapenem-resistant Enterobacteriaceae (CRE) are considered one of the most urgent health threats to humans according to the Centers for Disease Control (CDC), and the World Health Organization (WHO). A FimCH Vaccine expanded access study is being conducted in patients with a history of antibiotic resistant UTIs who are considered to be at risk for development of CRE UTI. This case series describes the clinical, safety and immunogenicity findings for four participants who received a FimCH four-vaccine series. Participants were followed for 12 months after administration of the fourth vaccine for safety, general health status and UTI occurrence. The study was later amended to allow additional follow-up of up to five years post vaccine administration to assess long-term health status, UTI occurrences and to obtain blood samples for anti-FimH antibody testing. In our population of 4 study participants, the number of symptomatic UTI occurrences caused by gram-negative bacteria in the 12-month period following peak anti-FimH antibody response were approximately 75% lower than the 12-month period preceding study enrollment. These results are consistent with the 30-patient cohort of a Phase 1 study with the same FimCH Vaccine. UTI occurrences increased during the long-term follow-up period for all 4 participants but did not reach the rate observed pre-vaccination. No new safety concerns related to the FimCH Vaccine were identified during long-term follow-up. This case series has clinical importance and public health relevance since it examines and reports on UTI frequency and recurrence following vaccination with the FimCH Vaccine in a high-risk population of patients with recurrent UTI. Additionally, participants described improved well-being following vaccination which was maintained in the long-term follow-up period.

Supporting Type 1 and Type 2 Diabetes Care in the Hemodialysis Unit: A Quality-improvement Initiative Throughout the COVID-19 Pandemic.

OBJECTIVE: People living with diabetes mellitus (DM) and chronic kidney disease can have difficulty attending multiple appointments to receive DM care. We developed and studied the utility of a DM outreach program to offer in the hemodialysis (HD) unit. METHODS: We conducted a quality improvement project in a satellite HD unit in London, Ontario, Canada, between August 1, 2019, and July 31, 2022. We assessed for baseline gaps in DM care among those with DM, performed root-cause analysis with key stakeholders to identify critical drivers of gaps, and conceptualized a certified diabetes educator-led outreach program to offer in the HD unit. We aimed to improve DM self-monitoring, hypo- and hyperglycemia, and DM-related screening. We used run and control charts to track outcome measures over time and modified our outreach program iteratively. RESULTS: Fifty-eight persons with DM receiving HD participated in our program. Support spanned multiple waves of the COVID-19 pandemic. With 4 tests of change, we observed improvement in DM self-monitoring with a modest decline in self-reported hyperglycemia. There were no adverse consequences, and satisfaction with our program was high. CONCLUSIONS: Although we did not meet all measures of success during the pandemic, outreach DM support in the HD unit appeared to improve self-monitoring and self-reported hyperglycemia. Similar programs could be modified and implemented in other centres.

Taxonomic attribution of the KNM-ER 1500 partial skeleton from the Burgi Member of the Koobi Fora Formation, Kenya.

Paranthropus boisei is well represented in the eastern African fossil record by craniodental remains, but very few postcranial fossils can be securely attributed to this taxon. For this reason, KNM-ER 1500 from East Turkana, Kenya, is especially important. KNM-ER 1500 is a badly weathered and fragmented postcranial skeleton associated with a small piece of mandibular corpus. It derives from the Burgi Member, which has yielded diagnostic craniodental fossils attributable to P. boisei, Homo habilis, Homo rudolfensis and Homo erectus. Although it has been proposed that KNM-ER 1500 may be attributable to P. boisei based on the small mandibular fragment, this hypothesis remained challenging to test. Here we re-examine the preserved portions of KNM-ER 1500 and reassess support for its taxonomic attribution. There are compelling features of the mandible, proximal femur, and especially the proximal radius that support attribution of KNM-ER 1500 to P. boisei. These features include the absolute width of the mandible and its lack of a lateral intertoral sulcus, an anteroposteriorly compressed femoral neck with a distinctive posteroinferior marginal ridge, the rim of the radial head that is proximodistally uniform in thickness around its circumference, and a long radial neck that is elliptical in cross section. No feature serves to align KNM-ER 1500 with Homo to the exclusion of Paranthropus. KNM-ER 1500 was a small-bodied individual and attributing this specimen to P. boisei confirms that significant postcranial-size dimorphism was present in this species.

Major Susceptibility Gene Epistasis over Minor Gene Resistance to Spot Form Net Blotch in a Commercial Barley Cultivar.

Spot form net blotch, caused by Pyrenophora teres f. maculata, is a significant global disease of barley (Hordeum vulgare). Baudin, a barley cultivar that was until recently extensively grown in Western Australia, was reported as having minor seedling resistance. However, Baudin was highly susceptible to a local isolate, M3, suggesting that this isolate had gained virulence against a major susceptibility gene. M3 causes atypical lesions with pale centers early in the infection, with initial screens of a segregating population indicating that this was determined by a single locus in the Baudin genome. The susceptibility was semidominant in F1 progeny and the susceptibility gene, designated Spm1 (Susceptibility to P. teres f. maculata 1), mapped to a 190-kb section of the resistance gene-rich Mla region of chromosome 1H. Phenotyping with Ptm SP1, a non-M3 pathotype, identified a seedling resistance locus on 2H. Minor gene resistance is generally regarded as potentially durable, but our findings suggest the resistance to spot form net blotch in Baudin is nullified by strong susceptibility conferred by a separate locus on 1H. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

How Do You Be Your Best Self in a Vexatious World?

How do we survive, let alone thrive, in health care? The complexity of providing care to patients and families on chronic kidney replacement therapy can be taxing for the most expert and resilient of health care professionals. Further complicating this by a global pandemic can produce feelings of frustration and anxiety that can reduce our effectiveness in the everyday, yet we are compelled to practice competently and professionally. Working on oneself is key to optimizing one's resilience during volatile, uncertain, complex, and ambiguous times. This article introduces the concept of emotional intelligence and provides a brief review of the brain science behind behavioral patterns, highlighting how all health care professionals can engage in self-work to bring our best selves to the every day.

An optimized sporulation method for the wheat fungal pathogen Pyrenophora tritici-repentis.

BACKGROUND: The necrotrophic fungal pathogen Pyrenophora tritici-repentis (Ptr) causes tan (syn. yellow) spot of wheat and accounts for significant yield losses worldwide. Understanding the molecular mechanisms of this economically important crop disease is crucial to counteract the yield and quality losses of wheat globally. Substantial progress has been made to comprehend the race structure of this phytopathogen based on its production of necrotrophic effectors and genomic resources of Ptr. However, one limitation for studying Ptr in a laboratory environment is the difficulty to isolate high spore numbers from vegetative growth with mycelial contamination common. These limitations reduce the experimental tractability of Ptr. RESULTS: Here, we optimized a multitude of parameters and report a sporulation method for Ptr that yields robust, high quality and pure spores. Our methodology encompasses simple and reproducible plugging and harvesting techniques, resulting in spore yields up to 1500 fold more than the current sporulation methods and was tested on multiple isolates and races of Ptr as well as an additional seven modern Australian Ptr isolates. Moreover, this method also increased purity and spore harvest numbers for two closely related fungal pathogens (Pyrenophora teres f. maculata and f. teres) that cause net blotch diseases in barley (Hordeum vulgare), highlighting the usability of this optimized sporulation protocol for the wider research community. CONCLUSIONS: Large-scale spore infection and virulence assays are essential for the screening of wheat and barley cultivars and combined with the genetic mapping of these populations allows pinpointing and exploiting sources of host genetic resistance. We anticipate that improvements in spore numbers and purity will further advance research to increase our understanding of the pathogenicity mechanisms of these important fungal pathogens.

Morphological integration of the canine region within the hominine alveolar arch.

The early hominin record is characterized by numerous shifts in dental proportions (e.g., canine reduction and megadontia) linked to changes in diet and social behavior. Recent studies suggest that hominins exhibit a reduction in the magnitude of covariation between the anterior and posterior dental components compared with other extant great apes. They point toward, but do not directly test, the relative independence of canine morphology within the hominin alveolar arch. This study focuses specifically on the how the canine region covaries with other regions of the dental arch because the canine region has drastically reduced in size and changed in shape across human evolution. We examine extant primate species most commonly used as a comparative framework for fossil hominin morphology: Gorilla gorilla (n = 27), Pan troglodytes (n = 27), and Homo sapiens (n = 30). We used geometric morphometric methods to test for size and shape covariation between the canine region with other dental regions. We also examined the influence of sexual dimorphism and allometry on intraspecific and interspecific patterns of covariation. The analysis of size and shape covariation between the mandibular canine and other individual tooth regions elucidated complex, species-specific, and sex-specific morphological relationships in the mandibular alveolar arch. There was little evidence to support different patterns of morphological integration between humans on the one hand and nonhuman apes on the other. Canine region morphology was relatively independent from other dental regions across species based on shape and did not significantly covary more with either the incisor or postcanine region in any species. The size correlations between the canine and other dental regions were moderate to high. The species-specific results of this study question the ability to make a priori assumptions about morphological integration in the extant hominin mandibular alveolar arch and its application to the fossil record.

Heterogeneous frailty and the expression of linear enamel hypoplasia in a genealogical population.

OBJECTIVES: Linear enamel hypoplasia (LEH) is a common skeletal marker of physiological stress (e.g., malnutrition or illness) that is studied within and across populations, without reference to familial risk. We examine LEH prevalence in a population with known genealogical relationships to determine the potential influence of genetic heritability and shared environment. METHODS: LEH data of 239 individuals from a single population were recorded from the Ohio State University Menegaz-Bock collection dental casts. All individuals were of known age, sex, and genealogy. Narrow-sense heritability estimates were obtained for LEH presence and count data from all unworn, fully erupted teeth (excluding third molars) using SOLAR (v.8.1.1). Age, sex, and age-sex interaction were included as covariates. Models were re-run with a household effect variable. RESULTS: LEH persists across generations in this study population with moderate, significant heritability estimates for presence in four teeth, and count in four teeth (three teeth were significant for both). When a household effect variable was added, no residual heritability remained for LEH count on any tooth. There was no significant household effect for three of the four teeth that had significant heritability estimates for LEH presence. Age was a significant covariate. Further analyses with birth year data revealed a secular trend toward less LEH. CONCLUSIONS: This study provides evidence for familial risk of LEH (genetic and environmental) that has consequences for the broad use of this skeletal marker of stress. These results have repercussions for archaeological assemblages, or population health studies, where genetic relatives and household groups might be heavily represented.

Potentiators of Disease During Barley Infection by Pyrenophora teres f. teres in a Susceptible Interaction.

Pyrenophora teres f. teres is a necrotrophic fungal pathogen and causal agent of net form net blotch (NFNB), a significant disease of barley. RNA-seq data encompassing asymptomatic and subsequent necrotrophic phases of the pathogen was obtained for P. teres f. teres isolate W1-1 in NFNB-sensitive cultivar Baudin. Host genes notably regulated during infection included concerted induction of over half the repertoire of disease resistance genes, together with genes involved in oxidation-reduction processes, characteristic of a hypersensitive response. Several systemic acquired resistance response genes were suppressed and there was a complete absence of defense-related thionin gene expression. In P. teres f. teres, genes involved in hydrolase activities and cell-wall catabolic processes were induced during infection, while nitrate assimilation and response to oxidative stress processes were suppressed. Timecourse data allowed a number of predicted P. teres f. teres effector genes with differing expression profiles to be identified that may underlie barley sensitivity to NFNB. Candidate genes involved in the host-pathogen interaction provide a basis for functional characterization and control strategies based on fungicide or mutation targets, which will facilitate further research aimed at controlling NFNB disease.[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Ultra-Processed Food Intake and Associations With Demographic Factors in Young New Zealand Children.

BACKGROUND: Children consume ultra-processed food (UPF) from a young age, but the proportional contribution of UPF to young children's total energy intakes has not been evaluated in developed countries. OBJECTIVES: To describe UPF intake and associations with demographic factors in young children from 12 to 60 months of age. DESIGN: Cohort study comprising a secondary analysis of data from a randomized controlled trial. Demographic data were collected by questionnaire. At 12, 24, and 60 months of age validated food frequency questionnaires estimated percentage of energy intake from UPF (%kcal UPF). PARTICIPANTS/SETTING: The 669 children were born in Dunedin, New Zealand, between May 2009 and December 2010. MAIN OUTCOME MEASURES: Mean percentage of energy intake from UPF at 12, 24, and 60 months of age, mean differences in %kcal UPF by demographic variables. STATISTICAL ANALYSES PERFORMED: Mixed effects regression models were used to estimate relationships between demographics and %kcal UPF. Multiple imputation methods were used to impute missing UPF data. RESULTS: UPF contributed mean (95% confidence interval) 45% (44%, 47%), 42% (41%, 44%), and 51% (50%, 52%) of energy intake to the diets of children at 12, 24, and 60 months of age, respectively. Energy intake from UPF was moderately correlated between 24 and 60 months (r = 0.36). No demographic factors were associated with mean %kcal UPF across time points, except for maternal obesity predicting higher UPF intake at 12 months. Bread, yoghurt, crackers, whole-wheat breakfast cereal, sausages, and muesli bars were among the 10 foods making the greatest contribution to mean %kcal UPF intakes at all time points. CONCLUSIONS: UPF contribute a substantial proportion of energy to the diets of young children. A range of foods with varying nutritional profiles contribute to these high intakes.

Sleep and Sensory Processing in Infants and Toddlers: A Cross-Sectional and Longitudinal Study.

IMPORTANCE: Typically developing children who are sensitive to sensory stimulation appear to have more sleep difficulties than children with average sensory sensitivities; however, at what age sleep difficulties emerge and whether they extend to children outside of sleep clinics are unclear. OBJECTIVE: To investigate cross-sectional and longitudinal relationships between sleep and sensory processing in typically developing infants and toddlers. DESIGN: Observational; cross-sectional and longitudinal. SETTING: Community. PARTICIPANTS: Children (N = 160) enrolled in a larger four-armed randomized controlled trial of overweight prevention in infancy (40 randomly selected from each arm). OUTCOMES AND MEASURES: Parent-reported sleep patterns at ages 6 mo, 1 yr, 2 yr, and 2.5 yr. Sensory Processing Measure-Preschool questionnaire covering five sensory systems and higher level functions: praxis and social participation at age 2.5 yr. Relationships between sleep and sensory variables were analyzed using multiple linear regression models. RESULTS: More problematic sleep at age 2.5 yr was associated with more difficulties in social-relational skills (p < .001), a finding supported by the longitudinal data. Longer settling times were associated with higher vision (p = .036) and touch (p = .028) sensitivities at age 2.5 yr; in the longitudinal data (ages 6 mo-2.5 yr), longer settling times were associated with more sensitive hearing (p = .042). CONCLUSIONS AND RELEVANCE: Results support a link between sleep patterns and sensory processing difficulties in toddlers that, in some, can emerge in infancy. Practitioners should be alert to this association in young children presenting with sensory sensitivity or sleep challenges. WHAT THIS ARTICLE ADDS: Study findings illustrate that bedtime challenges in typically developing toddlers could be related to sensory processing. A possible way to assist more sensitive children in settling to sleep is to pay attention to visual, tactile, and auditory stimuli that potentially interfere with sleep onset.

Understanding, comparing and learning from the four EPOCH early childhood obesity prevention interventions: A multi-methods study.

BACKGROUND: Childhood obesity is a global problem. Early obesity prevention interventions are complex and differ in effectiveness. Novel frameworks, taxonomies and experience from the Early Prevention of Obesity in CHildren (EPOCH) trials were applied to unpack interventions. OBJECTIVES: Deconstruct interventions into their components (target behaviours, delivery features and behaviour change techniques [BCTs]). Identify lessons learned and future recommendations for intervention planning, delivery, evaluation and implementation. METHODS: This multi-methods study deconstructed the four EPOCH interventions into target behaviours, delivery features and BCTs from unpublished and published materials using systematic frameworks. Additionally, semi-structured interviews were conducted with intervention facilitators and principal investigators. RESULTS: Each trial targeted between 10 and 14 obesity-related behaviours. Key variations in delivery features related to intensity, delivery mode and tailoring. BCTs consistently used across trials included goal-setting, social support, shaping knowledge, role-modelling and credible source. Recommendations from interview analyses include the importance of stakeholder collaboration and consideration of implementation throughout the study process. CONCLUSIONS: The combination of frameworks, methodologies and interviews used in this study is a major step towards understanding complex early obesity prevention interventions. Future work will link systematic intervention deconstruction with quantitative models to identify which intervention components are most effective and for whom.

Reference Genome Assembly for Australian Ascochyta rabiei Isolate ArME14.

Ascochyta rabiei is the causal organism of ascochyta blight of chickpea and is present in chickpea crops worldwide. Here we report the release of a high-quality PacBio genome assembly for the Australian A. rabiei isolate ArME14. We compare the ArME14 genome assembly with an Illumina assembly for Indian A. rabiei isolate, ArD2. The ArME14 assembly has gapless sequences for nine chromosomes with telomere sequences at both ends and 13 large contig sequences that extend to one telomere. The total length of the ArME14 assembly was 40,927,385 bp, which was 6.26 Mb longer than the ArD2 assembly. Division of the genome by OcculterCut into GC-balanced and AT-dominant segments reveals 21% of the genome contains gene-sparse, AT-rich isochores. Transposable elements and repetitive DNA sequences in the ArME14 assembly made up 15% of the genome. A total of 11,257 protein-coding genes were predicted compared with 10,596 for ArD2. Many of the predicted genes missing from the ArD2 assembly were in genomic regions adjacent to AT-rich sequence. We compared the complement of predicted transcription factors and secreted proteins for the two A. rabiei genome assemblies and found that the isolates contain almost the same set of proteins. The small number of differences could represent real differences in the gene complement between isolates or possibly result from the different sequencing methods used. Prediction pipelines were applied for carbohydrate-active enzymes, secondary metabolite clusters and putative protein effectors. We predict that ArME14 contains between 450 and 650 CAZymes, 39 putative protein effectors and 26 secondary metabolite clusters.

Optimized plant compound with potent anti-biofilm activity across gram-negative species.

Many human diseases, including cystic fibrosis lung infections, are caused or exacerbated by bacterial biofilms. Specialized modes of motility, including swarming and twitching, allow gram-negative bacteria to spread across surfaces and form biofilms. Compounds that inhibit these motilities could slow the spread of biofilms, thereby allowing antibiotics to work better. We previously demonstrated that a set of plant-derived triterpenes, including oleanolic acid and ursolic acid, inhibit formation of Escherichia coli and Pseudomonas aeruginosa biofilms, and alter expression of genes involved in chemotaxis and motility. In the present study, we have prepared a series of analogs of oleanolic acid. The analogs were evaluated against clinical isolates of E. coli and P. aeruginosa in biofilm formation assays and swarming assays. From these analogs, compound 9 was selected as a lead compound for further development. Compound 9 inhibits E. coli biofilm formation at 4 µg/mL; it also inhibits swarming at ≤1 µg/mL across multiple clinical isolates of P. aeruginosa, E. coli, Burkholderia cepacia, and Salmonella enterica, and at <0.5 µg/mL against multiple agricultural strains. Compound 9 also potentiates the activity of the antibiotics tobramycin and colistin against swarming P. aeruginosa; this is notable, as tobramycin and colistin are inhaled antibiotics commonly used to treat P. aeruginosa lung infections in people with cystic fibrosis. qPCR experiments suggested that 9 alters expression of genes involved in regulating Type IV pili; western blots confirmed that expression of Type IV pili components PilA and PilY1 decreases in P. aeruginosa in the presence of 9.

Using compositional principal component analysis to describe children's gut microbiota in relation to diet and body composition.

BACKGROUND: Gut microbiota data obtained by DNA sequencing are complex and compositional because of large numbers of detectable taxa, and because microbiota characteristics are described in relative terms. Nutrition researchers use principal component analysis (PCA) to derive dietary patterns from food data. Although compositional PCA methods are not commonly used to describe patterns from complex microbiota data, this approach would be useful for identifying gut microbiota patterns associated with diet and body composition. OBJECTIVES: To use compositional PCA to describe the principal components (PCs) of gut microbiota in 5-y-old children and explore associations between microbiota components, diet, and BMI z-score. METHODS: A fecal sample was provided by 319 children aged 5 y. Their primary caregiver completed a validated 123-item quantitative FFQ. Body composition was determined using DXA, and a BMI z-score was calculated. Compositional PCA identified characterizing taxa and weightings for calculation of gut microbiota PC scores at the genus level, and was examined in relation to diet and body size. RESULTS: Three gut microbiota PCs were found. PC1 (negative loadings on uncultured Christensenellaceae and Ruminococcaceae) was related to lower BMI z-scores and longer duration of breastfeeding (per month) (ß = -0.14; 95% CI: -0.26, -0.02; and ß = 0.02; 95% CI: 0.003, 0.34, respectively). PC2 (positive loadings on Fusicatenibacter and Bifidobacterium; negative loadings on Bacteroides) was associated with a lower intake of nuts, seeds, and legumes (ß = -0.05 per gram; 95% CI: -0.09, -0.01). When adjusted for fiber intake, PC2 was also associated with higher BMI z-scores (ß = 0.12; 95% CI: 0.01, 0.24). PC3 (positive loadings on Faecalibacterium, Eubacterium, and Roseburia) was associated with higher intakes of fiber (ß = 0.02 per gram; 95% CI: 0.003, 0.04) and total nonstarch polysaccharides (ß = 0.02 per gram; 95% CI: 0.003, 0.04). CONCLUSIONS: Our results suggest that specific gut microbiota components determined using compositional PCA are associated with diet and BMI z-score.This trial was registered at clinicaltrials.gov as NCT00892983.

Consistent use of bedtime parenting strategies mediates the effects of sleep education on child sleep: secondary findings from an early-life randomized controlled trial.

OBJECTIVE: Using data from a randomized controlled trial, this study investigated whether parent's consistent use of recommended bedtime strategies with infants was a mediating mechanism for improved child sleep. METHODS: Expectant mothers were allocated to 4 groups: usual care (Control); additional support regarding Food, (physical) Activity, and Breastfeeding (FAB); advice on infant sleep through 1 group educational session during the antenatal period and 1 home visit when the child was 3 weeks of age (Sleep), or both FAB and Sleep interventions (Combination). An index relating to parent's consistent use of strategies to encourage infant sleep self-settling was developed from data collected when infants were 4 and 6 months of age. Child sleep self-control was measured at 3.5 years of age through a behavior rating scale. Child overnight sleep duration was measured using accelerometers at 1, 2, 3.5, and 5 years of age. Analyses examined whether any association between intervention group and child sleep self-control or sleep duration was mediated by consistent use of bedtime strategies at 4 and 6 months. RESULTS: Compared to Controls, Sleep group parents had significantly higher odds of using more intervention strategies consistently (1.63; 95% confidence interval [CI] 1.14-2.33), as did Combination group parents (1.45; 95% CI 1.01-2.07). Consistent strategy use was significantly associated with a decrease in child bedtime behavioral difficulties (0.97; 95% CI 0.95-0.98) and increased sleep duration (0.152; SE = 0.017). Sleep group assignment reduced child sleep self-control difficulties and improved sleep duration indirectly via parent's consistent use of bedtime strategies. DISCUSSION: Consistent use of appropriate bedtime strategies in infancy is an important factor that influences child sleep self-control in later development.

Examining the accuracy of the New Zealand B4 School Check universal health service anthropometric measurements of children.

BACKGROUND: The aim of the current study was to determine whether anthropometric data from the New Zealand B4 School Check (B4SC) universal health service assessments are comparable to research grade anthropometric data. METHODS: B4SC anthropometric data were obtained for a subsample (n=394) of children who participated in the Prevention of Overweight in Infancy (POI) randomised control trial. B4SC anthropometric measures were compared to POI anthropometric values that had been interpolated to align with the date of the B4SC assessment. RESULTS: Interclass correlation coefficients between values from the two sources (0.93-0.98) suggested that across all these measures, most variation depended on between child effects rather than between source effects. A paired t-test found no evidence for differences between POI and B4SC height values. B4SC weights were a mean of 0.45kg heavier, and BMIs a mean of 0.41kg/m2 greater. Exploratory analyses demonstrated that greater overestimation of weight by the B4SC was associated with assessments on colder days. CONCLUSION: B4SC measurements of weight were greater than values obtained from interpolating the POI standardised research assessments. Interestingly, this overestimation was inversely associated with the average temperature on the day when the B4SC occurred. These findings suggest that universal health services that monitor growth in children could be improved by including standardised procedures to account for non-removal of clothing.

A Qualitative Study of How Preschoolers' Problematic Sleep Impacts Mothers.

BACKGROUND: Sleep disturbances are common among preschool-aged children. As children's problematic sleep is commonly defined by subjective reports from parents as to how the issue affects them, we took a qualitative approach to explore the perceptions and experiences of mothers and main caregivers of preschoolers with problematic sleep. The aim was to understand their firsthand experiences. METHODS: Purposive sampling was used to identify mothers of 3- to 4-year-olds whose sleep was a problem for them. Semistructured interviews were conducted with 16 mothers. The interviews were analyzed for anticipated and emergent themes, the latter generated from exploring the impact of the child's sleep problems on the mother herself. RESULTS: Mothers described difficulties mainly with bedtime resistance and night waking and the adverse consequences affecting siblings and partners. Predominant themes falling under the umbrella of emotional responses (e.g., resignation, guilt or shame, confusion or frustration, and defeat) and daytime functioning (e.g., exhaustion, moodiness, poorer concentration, less socializing) emerged from mothers describing the impact the child's sleep problem had on her personally. CONCLUSIONS: This study highlights the overwhelming impact a child's sleep problems can have on a mother both emotionally and physically, and expressions of shame and guilt suggest some mothers assume much of the responsibility for their child's sleep problem. The findings provide insight into understanding mothers' personal responses in dealing with their preschoolers' sleep that could be useful to assist health professionals in history taking and establishing a treatment plan.

Identifying developmental features in students' clinical reasoning to inform teaching.

BACKGROUND: There is increasing evidence that students at different levels of training may benefit from different methods of learning clinical reasoning. Two of the common methods of teaching are the "whole - case" format and the "serial cue" approach. There is little empirical evidence to guide teachers as to which method to use and when to introduce them. METHODS: We observed 23 students from different stages of training to examine how they were taking a history and how they were thinking whilst doing this. Each student interviewed a simulated patient who presented with a straightforward and a complex presentation. We inferred how students were reasoning from how they took a history and how they described their thinking while doing this. RESULTS: Early in their training students can only take a generic history. Only later in training are they able to take a focused history, remember the information they have gathered, use it to seek further specific information, compare and contrast possibilities and analyze their data as they are collecting it. CONCLUSIONS: Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the "serial cue" approach of teaching clinical reasoning.

24-h movement behaviors from infancy to preschool: cross-sectional and longitudinal relationships with body composition and bone health.

BACKGROUND: New physical activity guidelines for children address all movement behaviors across the 24-h day (physical activity, sedentary behavior, sleep), but how each component relates to body composition when adjusted for the compositional nature of 24-h data is uncertain. AIMS: To i) describe 24-h movement behaviors from 1 to 5 years of age, ii) determine cross-sectional relationships with body mass index (BMI) z-score, iii) determine whether movement behaviors from 1 to 5 years of age predict body composition and bone health at 5 years. METHODS: 24-h accelerometry data were collected in 380 children over 5-7 days at 1, 2, 3.5 and 5 years of age to determine the proportion of the day spent: sedentary (including wake after sleep onset), in light (LPA) and moderate-to-vigorous physical activity (MVPA), and asleep (including naps). BMI was determined at each age and a dual-energy x-ray absorptiometry (DXA) scan measured fat mass, bone mineral content (BMC) and bone mineral density (BMD) at 5 years of age. 24-h movement data were transformed into isometric log-ratio co-ordinates for multivariable regression analysis and effect sizes back-transformed. RESULTS: At age 1, children spent 49.6% of the 24-h day asleep, 38.2% sedentary, 12.1% in LPA, and 0.1% in MVPA, with corresponding figures of 44.4, 33.8, 19.8 and 1.9% at 5 years of age. Compositional time use was only related significantly to BMI z-score at 3.5 years in cross-sectional analyses. A 10% increase in mean sleep time (65 min) was associated with a lower BMI z-score (estimated difference, - 0.25; 95% CI, - 0.42 to - 0.08), whereas greater time spent sedentary (10%, 47 min) or in LPA (10%, 29 min) were associated with higher BMI z-scores (0.12 and 0.08 respectively, both p < 0.05). Compositional time use from 1 to 3.5 years was not related to future BMI z-score or percent fat. Although MVPA at 2 and 3.5 years was consistently associated with higher BMD and BMC at 5 years, actual differences were small. CONCLUSIONS: Considerable changes in compositional time use occur from 1 to 5 years of age, but there is little association with adiposity. Although early MVPA predicted better bone health, the differences observed had little clinical relevance. TRIAL REGISTRATION: ClinicalTrials.gov number NCT00892983 .