Glucocorticoid prescribing in neurology.

Glucocorticoids are commonly used for neurological disorders, but they can have significant adverse effects, including adrenal insufficiency, hyperglycaemia, osteoporosis and increased infection risk. Long-term use of corticosteroids requires the prescriber to plan risk mitigation, including monitoring and often coprescribing. This article highlights the potential risks of corticosteroid prescribing and draws together up-to-date guidance with multispecialty input to clarify ways of reducing those risks. We discuss home blood glucose monitoring and consider a steroid safety checklist to promote safer steroid prescribing.

Using the Triangle of Human Ecology for understanding self-rated depression: A quantitative study based on the HUNT 3 cohort.

AIMS: To test the Triangle of Human Ecology by examining associations between unipolar depression and different measures of human biological factors, health behaviour, and the physical environment. METHODS: Data originate from the third wave of the Nord-Trøndelag Health Study (2006-2008). The survey was based on a random sample of 50,000 Norwegians (response rate: 54%). Logistic regression was performed, using unipolar depression, measured with the Hospital Anxiety and Depression Scale score, as outcome variable and 38 explanatory variables. RESULTS: Biological factors including older age and male gender were associated with higher odds of depression, as were behavioural factors including drinking behaviour and having a neurotic personality. Reduced odds were associated with units of alcohol consumed, extrovert personality and physical activity. Social networks were an environmental factor with reduced odds at both personal and neighbourhood levels, as was warmer outdoor temperatures. CONCLUSIONS: Using the Triangle of Human Ecology provides a holistic insight into how behaviour, biology and the environment influence mental health.

A whole family-based physical activity promotion intervention: findings from the families reporting every step to health (FRESH) pilot randomised controlled trial.

INTRODUCTION: This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a theory-based child-led family physical activity (PA) intervention delivered online. We also assessed the preliminary effectiveness of the intervention on outcomes of interest and whether pre-specified criteria were met to progress to a full-scale definitive trial. METHODS: In a three-armed randomised pilot trial, 41 families (with a 7-11-year-old index child) were allocated to a: 'family' (FAM), 'pedometer-only' (PED), or a no-treatment control (CON) arm. The FAM arm received access to the FRESH website, allowing participants to select step challenges to 'travel' to target cities around the world, log their steps, and track progress as families virtually globetrot. FAM and PED arms also received family sets of pedometers. All family members could participate in the evaluation. Physical (e.g., fitness, blood pressure), psychosocial (e.g., social support), behavioural (e.g., objectively-measured PA), and economic (e.g., expenditure for PA) data were collected at baseline, 8- and 52-weeks. RESULTS: At 8- and 52-weeks, 98 and 88% of families were retained, respectively. Most children liked participating in the study (> 90%) and thought it was fun (> 80%). Compared to the PED (45%) and CON (39%) arms, a higher percentage of children in the FAM (81%) arm reported doing more activities with their family. Adults agreed that FRESH encouraged their family do more PA and made their family more aware of the amount of PA they do. No notable between-group differences were found for childrens' minutes in moderate-to-vigorous PA. Sizeable changes of 9.4 (95%CI: 0.4, 18.4) and 15.3 (95%CI: 6.0, 24.5) minutes in moderate-to-vigorous PA was found for adults in the FAM group compared to those in the PED or CON groups, respectively. No other notable differences were found. CONCLUSION: This study demonstrates feasibility and acceptability of the FRESH intervention. All progression criteria were at least partially satisfied. However, we failed to recruit the target sample size and did not find a signal of effectiveness on PA particularly long-term or in children. Further refinements are required to progress to a full-scale trial. TRIAL REGISTRATION: This study was prospectively registered ( ISRCTN12789422 ) on 16/03/2016.

Primary care referral for knee MRI in the United Kingdom: Association with demography and subsequent surgical intervention.

BACKGROUND: Since 2008 primary care physicians (GPs) in our region have been allowed open access to knee MRI scans. There are questions about whether this changes referral practice and if it is an effective use of resources. PURPOSE: To describe the change in demographics of patients referred for knee MRI following implementation of a new referral pathway. STUDY TYPE: Retrospective observational study. POPULATION: All primary care referrals between 2008 and 2015 for knee MRI from a population of 900,000. FIELD STRENGTH/SEQUENCE: Not applicable. ASSESSMENT: Demographic profile and number of knee MRI referrals and subsequent arthroscopies. STATISTICAL TESTS: Comparisons between urban and rural populations used the t-test. Test for normality used Shapiro-Wilks. Comparison between abnormal MRI proportions used a chi-squared test. RESULTS: There were 23,928 knee MRI referrals (10,695 from GPs) between 2000 and 2015. MRI knee referrals rose from 210 in 2008 to 2379 in 2015. The average age of the patient decreased from 46.8 (SD = 14.9) in 2008 to 41.3 (SD = 14.7) in 2015. Conversion to arthroscopy declined from 15.4% to 10.2%, but there was no significant change in abnormal scan proportion. Conversion rates showed no significant difference between rural (9.6%) and urban populations (10.5%). Referral rates were significantly higher in low socioeconomic status areas (47.3% vs. 34.6%). The median referral rate per 1000 patients was 13.8 (interquartile range = 8.4). Referral rates varied widely between practices. DATA CONCLUSION: Despite a large rise in knee MRI referrals from primary care, there has been no substantial change in the age profile, suggesting that there has been no increase in inappropriate referral of elderly patients in whom MRI is unlikely to influence management. A modest decrease in the conversion rate to arthroscopy may be reasonably offset against a decrease in secondary care referrals. Socioeconomic status of the target population must be considered when planning primary care knee MRI services. LEVEL OF EVIDENCE: 4 Technical Efficacy Stage: 6 J. Magn. Reson. Imaging 2019.

Signature properties of water: Their molecular electronic origins.

Water challenges our fundamental understanding of emergent materials properties from a molecular perspective. It exhibits a uniquely rich phenomenology including dramatic variations in behavior over the wide temperature range of the liquid into water's crystalline phases and amorphous states. We show that many-body responses arising from water's electronic structure are essential mechanisms harnessed by the molecule to encode for the distinguishing features of its condensed states. We treat the complete set of these many-body responses nonperturbatively within a coarse-grained electronic structure derived exclusively from single-molecule properties. Such a "strong coupling" approach generates interaction terms of all symmetries to all orders, thereby enabling unique transferability to diverse local environments such as those encountered along the coexistence curve. The symmetries of local motifs that can potentially emerge are not known a priori. Consequently, electronic responses unfiltered by artificial truncation are then required to embody the terms that tip the balance to the correct set of structures. Therefore, our fully responsive molecular model produces, a simple, accurate, and intuitive picture of water's complexity and its molecular origin, predicting water's signature physical properties from ice, through liquid-vapor coexistence, to the critical point.

Residential neighbourhood greenspace is associated with reduced risk of incident diabetes in older people: a prospective cohort study.

BACKGROUND: Three cross sectional studies suggest that neighbourhood greenspace may protect against incident diabetes. This study uses data from a longitudinal study with a large sample size to investigate the association between greenspace and the occurrence of incident diabetes over time. METHODS: Data was from the European Prospective Investigation of Cancer Norfolk, UK, cohort, recruitment 1993-2007 (N = 23,865). Neighbourhoods were defined as 800 m circular buffers around participants' home locations, according to their home postcode (zip code). Greenspace exposure was defined as the percentage of the home neighbourhood that was woodland, grassland, arable land, mountain, heath and bog, according to the UK Land Cover Map. Cox proportional hazards regression examined the association between neighbourhood greenspace exposure and incident diabetes. The population attributable fraction assessed the proportion of diabetes cases attributable to exposure to least green neighbourhoods. Mediation analysis assessed if physical activity explained associations between greenspace and diabetes. Interaction analysis was used to test for the modifying effect of rurality and socio-economic status on the relationship between greenspace and diabetes. Models were adjusted for known and hypothesised confounders. RESULTS: The mean age of participants was 59 years at baseline and 55.1% were female. The mean follow-up time was 11.3 years. Individuals living in the greenest neighbourhood quartile had a 19% lower relative hazard of developing diabetes (HR 0.81; 95% CI 0.67, 0.99; p = 0.035; linear trend p = 0.010). The hazard ratio remained similar (HR 0.81; 95% CI 0.65, 0.99; p = 0.042) after adjusting for age, sex, BMI, whether a parent had been diagnosed with diabetes and socio-economic status at the individual and neighbourhood level. A HR of 0.97 was attributed to the pathway through physical activity in a fully adjusted model, although this was non-significant (95% CI 0.88, 1.08; p = 0.603). The incidence of diabetes in the least green neighbourhoods (with 20% greenspace on average) would fall by 10.7% (95% CI -2.1%, 25.2%; p = 0.106) if they were as green as the average neighbourhood observed across the whole cohort (59% greenspace on average). There were no significant interactions between rurality or socio-economic status and level of greenspace. CONCLUSIONS: Greener home neighbourhoods may protect against risk of diabetes in older adults, although this study does not support a mediation role for physical activity. Causal mechanisms underlying the associations require further investigation.

Perceived and Objectively Measured Environmental Correlates of Domain-Specific Physical Activity in Older English Adults.

We examine the relative importance of both objective and perceived environmental features for physical activity in older English adults. Self-reported physical activity levels of 8,281 older adults were used to compute volumes of outdoor recreational and commuting activity. Perceptions of neighborhood environment supportiveness were drawn from a questionnaire survey and a geographical information system was used to derive objective measures. Negative binominal regression models were fitted to examine associations. Perceptions of neighborhood environment were more associated with outdoor recreational activity (over 10% change per standard deviation) than objective measures (5-8% change). Commuting activity was associated with several objective measures (up to 16% change). We identified different environmental determinants of recreational and commuting activity in older adults. Perceptions of environmental supportiveness for recreational activity appear more important than actual neighborhood characteristics. Understanding how older people perceive neighborhoods might be key to encouraging outdoor recreational activity.

Hydrogen bonding and molecular orientation at the liquid-vapour interface of water.

We determine the molecular structure and orientation at the liquid-vapour interface of water using an electronically coarse grained model constructed to include all long-range electronic responses within Gaussian statistics. The model, fit to the properties of the isolated monomer and dimer, is sufficiently responsive to generate the temperature dependence of the surface tension from ambient conditions to the critical point. Acceptor hydrogen bonds are shown to be preferentially truncated at the free surface under ambient conditions and a related asymmetry in hydrogen bonding preference is identified in bulk water. We speculate that this bonding asymmetry in bulk water is the microscopic origin of the observed surface structure.

Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study.

BACKGROUND: Few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people. METHOD: The postcodes of the 2,424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE ≤ 25), dementia (organicity level ≥3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years. RESULTS: Higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated. CONCLUSION: Features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies.

Change in objectively measured physical activity during the transition to adolescence.

BACKGROUND: Physical activity (PA) declines during adolescence but change in different PA intensities across population subgroups is rarely explored. We describe change in sedentary (SED) time, light (LPA), moderate (MPA) and vigorous PA (VPA) assessed at three time points over 4 years. METHODS: Accelerometer-assessed PA (min) was obtained at baseline (N=2064), 1 and 4 years later among British children (baseline mean±SD 10.2±0.3-year-old; 42.5% male). Change in SED (<100 counts/min (cpm)), LPA (101-1999 cpm), MPA (2000-3999 cpm) and VPA (≥4000 cpm) was studied using three-level (age, individual and school) mixed-effects linear regression including participants with data at ≥2 time points (N=990). Differences in change by sex, home location and weight status were explored with interactions for SED, LPA and moderate and vigorous PA (MVPA). RESULTS: SED increased by 10.6 (95% CI 9.1 to 12.2) min/day/year. MPA and VPA decreased by 1.4 (1.0 to 1.8) and 1.5 (1.1 to 1.8) min/day/year, respectively. VPA decreased more than MPA as a percentage of the baseline value. MVPA declined more steeply among boys (3.9 (3.0 to 4.8)) versus girls (2.0 (1.2 to 2.7) min/day/year) despite lower MVPA among girls at all ages; rural (4.4 (3.5 to 5.2)) versus urban individuals (1.3 (0.4 to 2.3) min/day/year) and on weekends (6.7 (5.2 to 8.1)) versus weekdays (2.8 (1.9 to 3.7) min/day/year). MVPA was consistently lower among overweight/obese individuals (-17.5 (-3.9 to -2.5) min/day/year). CONCLUSIONS: PA decreases and is replaced by SED during early adolescence in British youth. Results indicate the urgency of PA promotion among all adolescents but especially girls and in rural areas. Increasing VPA and targeting PA promotion during weekends appear important.

Predictors of change differ for moderate and vigorous intensity physical activity and for weekdays and weekends: a longitudinal analysis.

BACKGROUND: Predictors of physical activity (PA) change are rarely investigated separately for different PA intensities and for weekdays/weekends. We investigated whether individual-level predictors of one-year change in objectively-measured physical activity differ for moderate PA (MPA) and vigorous PA (VPA) and for weekends and weekdays. METHODS: Accelerometer-assessed PA (mins) was obtained at baseline and +1 year (n = 875, 41.5% male, Mean ± SD baseline age: 9.8 ± 0.4 years-old). Potential predictors (n = 38) were assessed at baseline from psychological (e.g., self-efficacy), socio-cultural (e.g., parent support) and environmental domains (e.g., land use). Associations between predictors and change in MPA (2000-3999 counts/minute (cpm)) and VPA (≥4000 cpm) separately for weekdays and weekends were studied using multi-level linear regression. Analyses were adjusted for school clustering, sex and baseline PA. RESULTS: Weekend PA declined (MPA decline 4.6 ± 21.8 mins/day; VPA decline: 2.1 ± 20.1 mins/day; both p < 0.001) whereas weekday PA did not significantly change. Higher baseline PA and being a girl were associated with greater PA declines in all four outcomes; remaining predictors differed for MPA and VPA and/or weekdays and weekends. Family logistic support was associated with less of a decline in weekend MPA (CI 95%) 0.15 (0.05, 0.25) and VPA 0.19 (0.09, 0.29), and peer support with less of a decline in weekday MPA 0.18 (0.02, 0.34) and VPA 0.22 (0.06, 0.38). CONCLUSIONS: Results highlight the relevance of investigating predictors of PA change separately for different PA intensities and for weekdays/weekends. In addition to continued focus on school PA promotion, more effort to target interventions during weekends, such as in the family and community appears important. Encouraging peer support to increase weekday PA and targeting parent support for weekend PA may be health promotion priorities.

Individual, socio-cultural and environmental predictors of uptake and maintenance of active commuting in children: longitudinal results from the SPEEDY study.

BACKGROUND: Active commuting is prospectively associated with physical activity in children. Few longitudinal studies have assessed predictors of change in commuting mode. PURPOSE: To investigate the individual, socio-cultural and environmental predictors of uptake and maintenance of active commuting in 10-year-old children. METHODS: Children were recruited in 2007 and followed-up 12 months later. Children self-reported usual travel mode to school. 31 child, parent, socio-cultural and physical environment characteristics were assessed via self-reported and objective methods. Associations with uptake and maintenance of active travel were studied using multi-level multiple logistic regression models in 2012. RESULTS: Of the 912 children (59.1% girls, mean ± SD baseline age 10.2 ± 0.3 yrs) with complete data, 15% changed their travel mode. Those children who lived less than 1 km from school were more likely to take up (OR: 4.73, 95% CI: 1.97, 11.32, p = 0.001) and maintain active commuting (OR: 2.80 95% CI: 0.98, 7.96, p = 0.02). Children whose parents reported it was inconvenient to use the car for school travel were also more likely to take up (OR: 2.04, 95% CI: 1.08, 3.85, p = 0.027) and maintain their active commuting (OR: 5.43 95% CI: 1.95, 15.13, p = 0.001). Lower socio-economic status and higher road safety were also associated with uptake. CONCLUSIONS: Findings from this longitudinal study suggest that reducing the convenience of the car and improving the convenience of active modes as well as improving the safety of routes to school may promote uptake and maintenance of active commuting and the effectiveness of these interventions should be evaluated.

Children's sedentary behaviour: descriptive epidemiology and associations with objectively-measured sedentary time.

BACKGROUND: Little is known regarding the patterning and socio-demographic distribution of multiple sedentary behaviours in children. The aims of this study were to: 1) describe the leisure-time sedentary behaviour of 9-10 year old British children, and 2) establish associations with objectively-measured sedentary time. METHODS: Cross-sectional analysis in the SPEEDY study (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people) (N=1513, 44.3% boys). Twelve leisure-time sedentary behaviours were assessed by questionnaire. Objectively-measured leisure-time sedentary time (Actigraph GT1M, <100 counts/minute) was assessed over 7 days. Differences by sex and socioeconomic status (SES) in self-reported sedentary behaviours were tested using Kruskal-Wallis tests. The association between objectively-measured sedentary time and the separate sedentary behaviours (continuous (minutes) and categorised into 'none' 'low' or 'high' participation) was assessed using multi-level linear regression. RESULTS: Sex differences were observed for time spent in most sedentary behaviours (all p ≤ 0.02), except computer use. Girls spent more time in combined non-screen sedentary behaviour (median, interquartile range: girls: 770.0 minutes, 390.0-1230.0; boys: 725.0, 365.0 - 1182.5; p = 0.003), whereas boys spent more time in screen-based behaviours (girls: 540.0, 273.0 - 1050.0; boys: 885.0, 502.5 - 1665.0; p < 0.001). Time spent in five non-screen behaviours differed by SES, with higher values in those of higher SES (all p ≤ 0.001). Regression analyses with continuous exposures indicated that reading (ß = 0.1, p < 0.001) and watching television (ß = 0.04, p < 0.01) were positively associated with objectively-measured sedentary time, whilst playing board games (ß = -0.12, p < 0.05) was negatively associated. Analysed in categorical form, sitting and talking (vs. none: 'low' ß = 26.1,ns; 'high' 30.9, p < 0.05), playing video games (vs. none: 'low' ß = 49.1, p < 0.01; 'high' 60.2, p < 0.01) and watching television (vs. lowest tertile: middle ß = 22.2,ns; highest ß = 31.9, p < 0.05) were positively associated with objectively-measured sedentary time whereas talking on the phone (vs. none: 'low' ß = -38.5, p < 0.01; 'high' -60.2, p < 0.01) and using a computer/internet (vs. none: 'low' ß = -30.7, p < 0.05; 'high' -4.2,ns) were negatively associated. CONCLUSIONS: Boys and girls and children of different socioeconomic backgrounds engage in different leisure-time sedentary behaviours. Whilst a number of behaviours may be predictive of total sedentary time, collectively they explain little overall variance. Future studies should consider a wide range of sedentary behaviours and incorporate objective measures to quantify sedentary time where possible.

Family and home influences on children's after-school and weekend physical activity.

BACKGROUND: Family- and home-related factors have been shown to be associated with children's physical activity (PA), but may be time-dependent. Here we investigate whether family- and home-related correlates of children's PA are different for the after-school period on weekdays than for the weekend. METHODS: Data on 21 family- and home-related variables and objectively measured PA (Actigraph GT1M) were available from 1608 Year 5 children (9-10 years old) from 92 schools in Norfolk participating in the SPEEDY (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people) study. Multi-level multiple linear regression was used to quantify cross-sectional associations between the family/home variables and average min per day of moderate-to-vigorous PA (MVPA, ≥2000 counts/min) after school on weekdays and at the weekend. Models were additionally adjusted for age, sex, BMI z-score and registered accelerometer wear time. RESULTS: After-school MVPA was associated with parent education (ß: -1.1; 95% CI -2.0 to -0.2), being allowed to play out in the neighbourhood (ß: 1.3; 0.7-1.8), restrictions on walking/cycling to friends' houses (ß: -1.1; -1.6 to -0.7), restrictions on sedentary behaviour (ß: -0.3; -0.5 to -0.02) and family social support (ß: 1.0; 0.7-1.3). Weekend MVPA was associated with number of siblings (ß: 2.6; 0.5-4.8), family encouragement (ß: 1.1; 0.2-2.0) and family social support (ß: 1.5; 0.5-2.5). CONCLUSION: Family social support is positively associated with children's out-of-school PA both at weekdays and in weekends. However, rules and restrictions appear to be important only on weekdays. The results of this study merit consideration when identifying appropriate timing of PA-promotion strategies.

School related factors and 1yr change in physical activity amongst 9-11 year old English schoolchildren.

BACKGROUND: Activity levels are known to decline with age and there is growing evidence of associations between the school environment and physical activity. In this study we investigated how objectively measured one-year changes in physical activity may be associated with school-related factors in 9- to 10-year-old British children. METHODS: Data were analysed from 839 children attending 89 schools in the SPEEDY (Sport, Physical Activity, and Eating behaviours: Environmental Determinants in Young People) study. Outcomes variables were one year changes in objectively measured sedentary, moderate, and vigorous physical activity, with baseline measures taken when the children were 9-10 years old. School characteristics hypothesised to be associated with change in physical activity were identified from questionnaires, grounds audits, and computer mapping. Associations were examined using simple and multivariable multilevel regression models for both school (9 am - 3 pm) and travel (8-9 am and 3-4 pm) time. RESULTS: Significant associations during school time included the length of the morning break which was found to be supportive of moderate (ß coefficient: 0.68 [p: 0.003]) and vigorous (ß coefficient: 0.52 [p: 0.002]) activities and helps to prevent adverse changes in sedentary time (ß coefficient: -2.52 [p: 0.001]). During travel time, positive associations were found between the presence of safe places to cross roads around the school and changes in moderate (ß coefficient: 0.83 [p:0.022]) and vigorous (ß coefficient: 0.56 [p:0.001]) activity, as well as sedentary time (ß coefficient: -1.61 [p:0.005]). CONCLUSION: This study suggests that having longer morning school breaks and providing road safety features such as cycling infrastructure, a crossing guard, and safe places for children to cross the road may have a role to play in supporting the maintenance of moderate and vigorous activity behaviours, and preventing the development of sedentary behaviours in children.

The impact of rainfall and school break time policies on physical activity in 9-10 year old British children: a repeated measures study.

BACKGROUND: The weather may be a driver of seasonal patterns in children's physical activity (PA). A better understanding of the relationships between weather and PA may help increase children's PA. This study aims to examine the association between PA and rainfall in 9-10 year old children, and how it may be modified by school policies. METHODS: 1794 participants in the SPEEDY study in Norfolk, UK recorded PA using ActiGraph accelerometers over up to six days in the summer term of 2007. Multilevel regression models were used to determine the day-by-day association between rainfall and minutes spent sedentary, in moderate-to-vigorous PA (MVPA), and average counts per minute (cpm) over the whole day (07:00-21:00) and the lunchtime period (12:00-14:00). School policies for break times in bad weather were fitted as interaction terms with rainfall. RESULTS: Relative to days with no rain, children spent 9.4 minutes (95%CI 7.0 to 11.9) fewer in MVPA, were sedentary for 13.6 minutes (8.8 to 18.4) more, and accumulated 85.9 cpm (66.2 to 105.5) fewer over the whole day on the wettest days. Children allowed to play outside in wet weather showed the lowest lunchtime PA levels on the wettest days, undertaking 9.8 minutes (6.2 to 13.5) fewer MVPA, 16.1 minutes (10.3 to 21.9) more sedentary, and accumulating 408.0 cpm (250.9 to 565.1) fewer than those allowed to be active indoors. CONCLUSIONS: Rainfall is negatively associated with PA in primary school children, but providing indoor physical activities in wet weather may help children maintain physical activity levels irrespective of rainfall.

Initial Clinical Laboratory Response to COVID-19: A Survey of Medical Laboratory Professionals.

OBJECTIVE: To explore the experiences of medical laboratory professionals (MLPs) and their perceptions of the needs of clinical laboratories in response to COVID-19. METHODS: We surveyed laboratory professionals working in United States clinical laboratories during the initial months of the pandemic. RESULTS: Overall clinical laboratory testing and overtime work for laboratorians decreased during the first months of the pandemic. Laboratory professionals reported better or unchanged job satisfaction, feelings toward their work, and morale in their workplace, which were related to healthcare facility and laboratory leadership response. They reported receiving in-kind gifts, but no hazard pay, for their essential work. Important supply needs included reagents and personal protective equipment (PPE). CONCLUSION: The response by healthcare facilities and laboratory leadership can influence MLPs job satisfaction, feelings toward their work, and laboratory morale during a pandemic. Current COVID-19 laboratory testing management, in the absence of sufficient reagents and supplies, cannot fully address the needs of clinical laboratories.

Long-Term Assessment of Lurasidone in Schizophrenia: Post Hoc Analysis of a 12-Month, Double Blind, Active-Controlled Trial and 6-Month Open-Label Extension Study.

INTRODUCTION: A post hoc analysis of a double-blind (DB) active control trial and an open-label extension (OLE) study was conducted to evaluate the long-term effects of lurasidone in patients with schizophrenia. METHODS: In the DB trial, patients were randomised to receive lurasidone or risperidone for 12 months. In OLE, all patients received lurasidone for an additional 6 months. Treatment-emergent adverse events (TEAEs) were evaluated. Efficacy assessments included relapse rate (DB trial only), and Positive and Negative Syndrome Scale, Clinical Global Impression-Severity scale, and Montgomery-Åsberg Depression Rating Scale. RESULTS: In the DB trial, patients with schizophrenia were randomised to lurasidone (n = 399) and risperidone (n = 190), of whom 129 and 84 continued into OLE, respectively. During the DB trial, incidence of TEAEs was similar for lurasidone (84.1%) and risperidone (84.2%). Lurasidone was associated with minimal changes in metabolic variables and prolactin levels, whereas risperidone was associated with clinically significant increases in prolactin and fasting glucose levels. The proportion of patients with metabolic syndrome was significantly lower in patients treated with lurasidone versus risperidone at the end of the DB trial (25.5% vs 40.4%; p = 0.0177). During OLE, patients switching from risperidone to lurasidone experienced a reduction in weight and prolactin levels; those continuing treatment with lurasidone experienced minimal changes in metabolic variables and prolactin. At the end of OLE, the proportion of patients with metabolic syndrome was no longer significantly different between groups (23.5% vs 31.5%; p = not significant). Efficacy outcomes were generally similar between groups during the DB trial, and were maintained during OLE. CONCLUSION: Lurasidone was generally well tolerated and effective in clinically stable schizophrenia patients over the long term. Lurasidone was also generally well tolerated and maintained effectiveness over 6 months in patients switching from risperidone. Patients switching from risperidone experienced improvements in metabolic parameters and prolactin levels. These findings confirm lurasidone's long-term effectiveness and favourable metabolic profile in patients with schizophrenia. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00641745.

A comparison of tracer kinetic models for T1-weighted dynamic contrast-enhanced MRI: application in carcinoma of the cervix.

The Tofts tracer kinetic models are often used to analyze dynamic contrast-enhanced MRI data. They are derived from a general two-compartment exchange model (2CXM) but assume negligible plasma mean transit time. The 2CXM estimates tissue plasma perfusion and capillary permeability-surface area; the Tofts models estimate the transfer constant K(trans), which reflects a combination of these two parameters. The aims of this study were to compare the 2CXM and Tofts models and report microvascular parameters in patients with cervical cancer. Thirty patients were scanned pretreatment using a dynamic contrast-enhanced MRI protocol with a 3 sec temporal resolution and a total scan duration of 4 min. Whole-tumor parameters were estimated with both models. The 2CXM provided superior fits to the data for all patients (all 30 P values < 0.005), and significantly different parameter estimates were obtained (P < 0.01). K(trans) (mean = 0.35 +/- 0.26 min(-1)) did not equal absolute values of tissue plasma perfusion (mean = 0.65 +/- 0.56 mL/mL/min) or permeability-surface area (mean = 0.14 +/- 0.09 mL/mL/min) but correlated strongly with tissue plasma perfusion (r = 0.944; P = 0.01). Average plasma mean transit time, calculated with the 2CXM, was 22 +/- 16 sec, suggesting the assumption of negligible plasma mean transit time is not appropriate in this dataset and the 2CXM is better suited for its analysis than the Tofts models. The results demonstrate the importance of selecting an appropriate tracer kinetic model in dynamic contrast-enhanced MRI.

Residential neighbourhood greenspace is associated with reduced risk of cardiovascular disease: A prospective cohort study.

BACKGROUND: Living in a greener neighbourhood may reduce the risk of developing incident cardiovascular disease, but evidence is limited by reliance on cross-sectional comparisons. We use data from a longitudinal study with a time-independent measure of risk to explore the association between exposure to greenspace and cardiovascular disease. METHODS: Data was from the European Prospective Investigation of Cancer Norfolk UK cohort, baseline 1993-1997 (n = 24,420). Neighbourhoods were defined as 800m radius zones around participants' home, according to their home postcode (zip code) in the year 2000. Greenspace exposure was identified using classified satellite imagery. Adjusted Cox proportional hazards regression examined associations between greenspace and incident cardiovascular disease. Mediation analysis assessed if physical activity mediated associations, whilst modification by rurality, socio-economic status and age was explored. RESULTS: The mean age of participants was 59.2 years at baseline, 54.7% were female, and mean follow-up time was 14.5 years. Individuals living in the greenest neighbourhood quartile had a 7% lower relative hazard of developing cardiovascular disease than other neighbourhoods (HR 0.93; 95% CI 0.88, 0.97; p = 0.003) after adjusting for age, sex, BMI, prevalent diabetes and socio-economic status (SES). Physical activity did not mediate the relationship (greenest compared to the least green quartile HR 0.99; 95% CI 0.97, 1.01; p = 0.416). Models predicted incidence of cardiovascular disease in the least green neighbourhoods (19.4% greenspace on average) would fall by 4.8% (95% CI 1.6%, 8.2% p = 0.003) if they were as green as the average neighbourhood (59.0% greenspace). Occupation moderated the relationship, whereby exposure to greenspace was not associated with incident CVD for participants engaged in manual occupations. CONCLUSIONS: Greener home neighbourhoods may protect against risk of cardiovascular disease even after accounting for SES, whilst the mechanism does not appear to be strongly associated with physical activity. Putative causal mechanisms require investigation.