Adult Cognitive Outcomes Following Childhood Mild Traumatic Brain Injury: A Scoping Review.

OBJECTIVE: This review aimed to (1) summarize the existing literature regarding cognitive outcomes in adults with a history of pediatric mild traumatic brain injury (mTBI) and (2) identify gaps in the literature to provide directions for future research. PARTICIPANTS: Participants sustained mTBI in childhood (0-17 years of age) and underwent cognitive assessment in adulthood (older than 18 years) at least 1 year postinjury. DESIGN: MEDLINE Ovid and PsycINFO Ovid databases were searched to identify original research studies that examined adult cognitive outcomes after childhood mTBI. MAIN MEASURES: Cognitive outcome measures assessed memory, attention, visuospatial abilities, processing speed, comprehension, reasoning, intellectual functioning, and executive functioning. Outcome measures ranged from self-reported cognitive symptoms to objective testing. RESULTS: A total of 4216 articles were screened, leading to the inclusion of 6 published studies for review (3 prospective cohort and 3 retrospective cohort), with 131 537 participants (mTBI = 6724; controls = 123 823). Review of the included articles suggests that adults with a history of childhood mTBI perform within the average range expected for adult cognitive functioning, although they may perform more poorly than non-head-injured comparison groups on a variety of cognitive measures. Injury-related factors, such as requiring electroencephalography within 24 hours of injury and posttraumatic amnesia lasting longer than 30 minutes, may be associated with variability in adult cognitive outcomes. CONCLUSION: The weight of the available evidence suggests that childhood mTBI does not have a significant impact on adult cognitive functioning. However, further research is needed to provide a more comprehensive understanding of the long-term cognitive outcomes of childhood mTBI and to identify predictors of those outcomes in adulthood.

Net illumination reduces fisheries bycatch, maintains catch value, and increases operational efficiency.

Small-scale fisheries are vital for food security, nutrition, and livelihoods in coastal areas throughout the world's oceans.1-9 As intricately linked social-ecological systems, small-scale fisheries require management approaches that help ensure both ecological and socioeconomic sustainability.7,10-14 Given their ease of use and lucrative nature, coastal gillnet fisheries are globally ubiquitous.10,15 However, these fisheries often result in high discarded capture of non-target organisms (bycatch) that can lead to significant cascading effects throughout trophic chains16-18 and costly fisheries restrictions that result in important revenue losses in coastal communities with scarce economic alternatives.19,20 Despite these challenges, few solutions have been developed and broadly adopted to decrease bycatch in coastal gillnet fisheries, particularly in developing nations.5,21 Here we used controlled experiments along Mexico's Baja California peninsula to show that illuminating gillnets with green LED lights-an emerging technology originally developed to mitigate sea turtle bycatch-significantly reduced mean rates of total discarded bycatch biomass by 63%, which included significant decreases in elasmobranch (95%), Humboldt squid (81%), and unwanted finfish (48%). Moreover, illuminated nets significantly reduced the mean time required to retrieve and disentangle nets by 57%. In contrast, there were no significant differences in target fish catch or value. These findings advance our understanding of how artificial illumination affects operational efficiency and changes in catch rates in coastal gillnet fisheries, while illustrating the value of assessing broad-scale ecological and socioeconomic effects of species-specific conservation strategies.

A Psychometric Assessment of the Suicidal Behaviors Questionnaire (SBQ-5) and Geriatric Suicide Ideation Scale-Screen (GSIS-screen) in Middle-Aged and Older Men.

Objectives. To investigate the psychometric properties of the five-item Suicidal Behaviors Questionnaire (SBQ-5) and the Geriatric Suicide Ideation Scale-Screen (GSIS-Screen, submitted) among community-residing middle-aged and older men.Methods. The SBQ-5 and GSIS-Screen were administered to 93 men, 55 years or older, who participated in an eligibility assessment (Time 1) for an upstream psychological intervention study to prevent the onset of suicide ideation among men struggling to transition to retirement. Eligible participants later completed the full GSIS and measures of depression and hopelessness at a pre-group assessment (Time 2).Results. The SBQ-5 was positively associated with the GSIS-Screen at the eligibility assessment. Internal consistency for both measures was low but acceptable. Time 1 scores on both screens predicted suicide ideation at Time 2, controlling for the intervening time lag and for baseline cognitive and physical functioning. Only the GSIS-Screen uniquely predicted future depression and hopelessness ratings.Conclusions. The SBQ-5 and the GSIS-Screen have acceptable psychometric properties among middle-aged and older community-residing men; the GSIS-Screen is more closely associated with later-life suicide risk factors.Clinical Implications. Brief screening tools may be of use in effectively identifying suicide ideation in community-residing middle-aged and older men.

Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?

BACKGROUND: The wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning. METHODS: We conducted multi-methods research over 33 months, incorporating national surveys of Directors of Public Health and local council elected members at two time-points, and in-depth case studies in five purposively selected geographical areas. RESULTS: Public health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. There is much change in the way public health commissioning is done, in who is doing it, and in what is commissioned, since the reforms. There is wider consultation on decisions in the local council setting than in the NHS, and elected members now have a strong influence on public health prioritisation. There is more (and different) scrutiny being applied to public health contracts, and most councils have embarked on wide-ranging changes to the health improvement services they commission. Public health money is being used in different ways as councils are adapting to increasing financial constraint. CONCLUSIONS: Our findings suggest that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned. Time (and further research) will tell if any of these changes lead to improved population health outcomes and reduced health inequalities, but many of the opportunities brought about by the reforms are threatened by the continued flux in the system.

Intrapopulation variability in the timing of ontogenetic habitat shifts in sea turtles revealed using δ15 N values from bone growth rings.

Determining location and timing of ontogenetic shifts in the habitat use of highly migratory species, along with possible intrapopulation variation in these shifts, is essential for understanding mechanisms driving alternate life histories and assessing overall population trends. Measuring variations in multi-year habitat-use patterns is especially difficult for remote oceanic species. To investigate the potential for differential habitat use among migratory marine vertebrates, we measured the naturally occurring stable nitrogen isotope (δ15 N) patterns that differentiate distinct ocean regions to create a 'regional isotope characterization', analysed the δ15 N values from annual bone growth layer rings from dead-stranded animals, and then combined the bone and regional isotope data to track individual animal movement patterns over multiple years. We used humeri from juvenile North Pacific loggerhead turtles (Caretta caretta), animals that undergo long migrations across the North Pacific Ocean (NPO), using multiple discrete regions as they develop to adulthood. Typical of many migratory marine species, ontogenetic changes in habitat use throughout their decades-long juvenile stage is poorly understood, but each potential habitat has unique foraging opportunities and spatially explicit natural and anthropogenic threats that could affect key life-history parameters. We found a bimodal size/age distribution in the timing that juveniles underwent an ontogenetic habitat shift from the oceanic central North Pacific (CNP) to the neritic east Pacific region near the Baja California Peninsula (BCP) (42·7 ± 7·2 vs. 68·3 ± 3·4 cm carapace length, 7·5 ± 2·7 vs. 15·6 ± 1·7 years). Important to the survival of this population, these disparate habitats differ considerably in their food availability, energy requirements and threats, and these differences can influence life-history parameters such as growth, survival and future fecundity. This is the first evidence of alternative ontogenetic shifts and habitat-use patterns for juveniles foraging in the eastern NPO. We combine two techniques, skeletochronology and stable isotope analysis, to reconstruct multi-year habitat-use patterns of a remote migratory species, linked to estimated ages and body sizes of individuals, to reveal variable ontogeny during the juvenile life stage that could drive alternate life histories and that has the potential to illuminate the migration patterns for other species with accretionary tissues.

THE EARTH SYSTEM PREDICTION SUITE: Toward a Coordinated U.S. Modeling Capability.

The Earth System Prediction Suite (ESPS) is a collection of flagship U.S. weather and climate models and model components that are being instrumented to conform to interoperability conventions, documented to follow metadata standards, and made available either under open source terms or to credentialed users. The ESPS represents a culmination of efforts to create a common Earth system model architecture, and the advent of increasingly coordinated model development activities in the U.S. ESPS component interfaces are based on the Earth System Modeling Framework (ESMF), community-developed software for building and coupling models, and the National Unified Operational Prediction Capability (NUOPC) Layer, a set of ESMF-based component templates and interoperability conventions. This shared infrastructure simplifies the process of model coupling by guaranteeing that components conform to a set of technical and semantic behaviors. The ESPS encourages distributed, multi-agency development of coupled modeling systems, controlled experimentation and testing, and exploration of novel model configurations, such as those motivated by research involving managed and interactive ensembles. ESPS codes include the Navy Global Environmental Model (NavGEM), HYbrid Coordinate Ocean Model (HYCOM), and Coupled Ocean Atmosphere Mesoscale Prediction System (COAMPS®); the NOAA Environmental Modeling System (NEMS) and the Modular Ocean Model (MOM); the Community Earth System Model (CESM); and the NASA ModelE climate model and GEOS-5 atmospheric general circulation model.

Integration, influence and change in public health: findings from a survey of Directors of Public Health in England.

BACKGROUND: Following the Health and Social Care Act in England, public health teams were formally transferred from the NHS to local authorities in April 2013. METHODS: Online survey of Directors of Public Health (DsPH) in local authorities in England (n = 152) to investigate their experience within local government 1 year on. Tests of association were used to explore relationships between the perceived integration and influence of public health, and changes in how the public health budget was being spent. RESULTS: The organization of and managerial arrangements for public health within councils varied. Most DsPH felt that good relationships had been established within the council, and the move had made them more able to influence priorities for health improvement, even though most felt their influence was limited. Changes in commissioning using the public health budget were already widespread and included the de-commissioning of services. CONCLUSIONS: There was a widespread feeling amongst DsPH that they had greater influence since the reforms, and that this went across the local authority and beyond. Public health's influence was most apparent when the transfer of staff to local government had gone well, when collaborative working relationships had developed, and when local partnership groups were seen as being effective.

The return of public health to local government in England: changing the parameters of the public health prioritization debate?

OBJECTIVES: To explore the influence of values and context in public health priority-setting in local government in England. STUDY DESIGN: Qualitative interview study. METHODS: Decision-makers' views were identified through semi-structured interviews and prioritization tools relevant for public health were reviewed. Interviews (29) were carried out with Health and Wellbeing Board members and other key stakeholders across three local authorities in England, following an introductory workshop. RESULTS: There were four main influences on priorities for public health investment in our case study sites: an organizational context where health was less likely to be associated with health care and where accountability was to a local electorate; a commissioning and priority-setting context (plan, do, study, act) located within broader local authority priority-setting processes; different views of what counts as evidence and, in particular, the role of local knowledge; and debates over what constitutes a public health intervention, triggered by the transfer of a public health budget from the NHS to local authorities in England. CONCLUSIONS: The relocation of public health into local authorities exposes questions over prioritizing public health investment, including the balance across lifestyle interventions and broader action on social determinants of health and the extent to which the public health evidence base influences local democratic decision-making. Action on wider social determinants reinforces not only the art and science but also the values and politics of public health.

Age and residency duration of loggerhead turtles at a North Pacific bycatch hotspot using skeletochronology.

For migratory marine animals, like sea turtles, effective conservation can be challenging because key demographic information such as duration of life stages and exposure to spatially explicit threats in different habitats are often unknown. In the eastern Pacific near the Baja California Peninsula (BCP), Mexico, tens of thousands of endangered North Pacific loggerhead sea turtles (Caretta caretta) concentrate at a foraging area known to have high rates of fishery bycatch. Because stage survivorship of loggerheads in the BCP will vary significantly depending on the number of years spent in this region, we applied skeletochronology to empirically estimate residency duration in this loggerhead hotspot. The observed age distribution obtained from skeletochronology analysis of 146 dead-stranded loggerheads ranged from three to 24 years old, suggesting a BCP residency of >20 years. Given the maximum estimated age and a one-year migration to western Pacific nesting beaches, we infer age-at-maturation for BCP loggerheads at ~25 years old. We also examine survivorship at varying BCP residency durations by applying our findings to current annual mortality estimates. Predicted survivorship of loggerheads spending over 20 years in this BCP foraging habitat is less than 10%, and given that ~43,000 loggerhead turtles forage here, a significant number of turtles are at extreme risk in this region. This is the first empirical evidence supporting estimated age-at-maturation for BCP North Pacific loggerheads, and the first estimates of BCP stage survivorship. Our findings emphasize the urgent need for continued and effective international conservation efforts to minimize bycatch of this endangered species.

Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water.

BACKGROUND: While previous research has suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism, few population level studies have been undertaken. In England, approximately 10% of the population live in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. This observational study examines the association between levels of fluoride in water supplies with practice level hypothyroidism prevalence. METHODS: We used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/2013 Quality and Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner registered patient numbers and 2012 practice level Index of Multiple Deprivation scores. FINDINGS: We found that higher levels of fluoride in drinking water provide a useful contribution for predicting prevalence of hypothyroidism. We found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area). INTERPRETATION: In many areas of the world, hypothyroidism is a major health concern and in addition to other factors-such as iodine deficiency-fluoride exposure should be considered as a contributing factor. The findings of the study raise particular concerns about the validity of community fluoridation as a safe public health measure.

The making of a productivity hotspot in the coastal ocean.

BACKGROUND: Highly productive hotspots in the ocean often occur where complex physical forcing mechanisms lead to aggregation of primary and secondary producers. Understanding how hotspots persist, however, requires combining knowledge of the spatio-temporal linkages between geomorphology, physical forcing, and biological responses with the physiological requirements and movement of top predators. METHODOLOGY/PRINCIPAL FINDINGS: Here we integrate remotely sensed oceanography, ship surveys, and satellite telemetry to show how local geomorphology interacts with physical forcing to create a region with locally enhanced upwelling and an adjacent upwelling shadow that promotes retentive circulation, enhanced year-round primary production, and prey aggregation. These conditions provide an area within the upwelling shadow where physiologically optimal water temperatures can be found adjacent to a region of enhanced prey availability, resulting in a foraging hotspot for loggerhead sea turtles (Caretta caretta) off the Baja California peninsula, Mexico. SIGNIFICANCE/CONCLUSIONS: We have identified the set of conditions that lead to a persistent top predator hotspot, which increases our understanding of how highly migratory species exploit productive regions of the ocean. These results will aid in the development of spatially and environmentally explicit management strategies for marine species of conservation concern.

Incentivizing preventive services in primary care: perspectives on Local Enhanced Services.

BACKGROUND: General practitioners in the UK play a key role in prevention but provision of preventive services is variable. The 2004 General Medical Services contract allows Primary Care Trusts (PCTs) to address health needs through providing locally agreed payments for Local Enhanced Services (LESs). This study identifies how this contractual flexibility is used for preventive services and explores its perceived effectiveness. METHODS: Semi-structured interviews were carried out (2008-09) in 10 purposively selected case study sites in England. Details of LESs for these sites were collected (2009) through Freedom of Information requests or local contacts. A national on-line survey of PCTs (2009) provided a national context for case study findings. RESULTS: LESs were considered to be effective in incentivizing preventive activity. However, specifications and performance management were often weak, awareness of how to optimize incentives was low and, as optional services, LESs were perceived to be at risk in a financial downturn. CONCLUSIONS: Using LESs for preventive services highlights gaps in 'core' primary care responsibilities and in the national pay-for-performance framework. Current incentive arrangements are complex, could increase inequalities and provide only a partial, short-term solution to developing a proactive approach to prevention in primary care.

Small-scale fisheries bycatch jeopardizes endangered Pacific loggerhead turtles.

BACKGROUND: Although bycatch of industrial-scale fisheries can cause declines in migratory megafauna including seabirds, marine mammals, and sea turtles, the impacts of small-scale fisheries have been largely overlooked. Small-scale fisheries occur in coastal waters worldwide, employing over 99% of the world's 51 million fishers. New telemetry data reveal that migratory megafauna frequent coastal habitats well within the range of small-scale fisheries, potentially producing high bycatch. These fisheries occur primarily in developing nations, and their documentation and management are limited or non-existent, precluding evaluation of their impacts on non-target megafauna. PRINCIPAL FINDINGS/METHODOLOGY: 30 North Pacific loggerhead turtles that we satellite-tracked from 1996-2005 ranged oceanwide, but juveniles spent 70% of their time at a high use area coincident with small-scale fisheries in Baja California Sur, Mexico (BCS). We assessed loggerhead bycatch mortality in this area by partnering with local fishers to 1) observe two small-scale fleets that operated closest to the high use area and 2) through shoreline surveys for discarded carcasses. Minimum annual bycatch mortality in just these two fleets at the high use area exceeded 1000 loggerheads year(-1), rivaling that of oceanwide industrial-scale fisheries, and threatening the persistence of this critically endangered population. As a result of fisher participation in this study and a bycatch awareness campaign, a consortium of local fishers and other citizens are working to eliminate their bycatch and to establish a national loggerhead refuge. CONCLUSIONS/SIGNIFICANCE: Because of the overlap of ubiquitous small-scale fisheries with newly documented high-use areas in coastal waters worldwide, our case study suggests that small-scale fisheries may be among the greatest current threats to non-target megafauna. Future research is urgently needed to quantify small-scale fisheries bycatch worldwide. Localizing coastal high use areas and mitigating bycatch in partnership with small-scale fishers may provide a crucial solution toward ensuring the persistence of vulnerable megafauna.

Comparing ectopic bone growth induced by rhBMP-2 on an absorbable collagen sponge in rat and rabbit models.

Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) is currently employed as an autograft replacement for spinal fusion. The morphogen is incorporated onto its carrier, an absorbable collagen sponge (ACS), in the operating room. Although the effectiveness of the rhBMP-2/ACS implant in stimulating bone formation in human subjects has now been well established, further investigations of its use are necessary to deepen our understanding of its performance. The objective of the present study was to determine whether fluid released from the rhBMP-2/ACS implant could induce bone growth in tissue sites away from the implant site. We first measured the amount of protein in the fluid released from the rhBMP-2-soaked ACS during intraoperative handling. Variables included soak time and degree of compression. In the compression group that most closely approximated intraoperative conditions, more than 95% of the rhBMP-2 protein was retained by the ACS following a 15-min. soak time. This in vitro study was followed by an in vivo ectopic implant experiment using rat and rabbit models. The animal investigation compared the amount of bone induced by rhBMP-2 solution alone versus the de novo bone formation induced by rhBMP-2/ACS implants with varying concentrations of rhBMP-2. No ossicles were found at the sites where rhBMP-2 solution was injected in either animal species. Twenty-two of the 24 subcutaneous sites in the rats implanted with the rhBMP-2/ACS constructs displayed the presence of the typical 4- and 12-week ossicle. There were no noticeable differences in the size and shape of the ossicles after 4 and 12 weeks. There was a greater percentage of implant sites without ossicles in the rabbits, compared to the rats.

Prenatal exposure of rats to valproic acid reproduces the cerebellar anomalies associated with autism.

Abnormalities in anatomy and function of the cranial nerve motor nuclei have been demonstrated in some people with autism and can be modeled in rats by exposure to valproic acid during neural tube closure. Reductions in Purkinje cell number and cerebellar volume, particularly of the posterior lobe, have also been reported in people with autism. Thus, a stereological examination of cerebellar morphology was undertaken in valproate-exposed rats. Compared to controls, rats exposed to a single dose of 600-mg/kg sodium valproate on embryonic day 12.5 had significantly fewer Purkinje cells in the cerebellar vermis and a reduction short of significant in the hemispheres. The diminished cell numbers reflect reductions in tissue volume throughout the cerebellum, rather than cell density, which was unaffected in all regions. Within the vermis, the reduction in volume was significantly greater in the posterior lobe than in the anterior lobe. The results parallel those reported for human cases of autism.

Primary care purchasing. Are integrated primary care provider/purchasers the way forward?

Integrated primary care provider/purchaser organisations are currently being developed in the UK and other countries. In common with many other European countries and New Zealand, there has been a swing away from market-orientated models of healthcare organisation towards models which blend centralised planning and quasi market approaches. Primary care groups in the UK and independent practice organisations in New Zealand provide new opportunities to combine micromanagement techniques in the delivery of patient care and approaches to improving population health. These new organisations are building on the experience of health maintenance organisations (HMOs) in the US and physician-led purchasing in the UK and other countries. However, there are distinct differences between countries due to differences in health and social care systems and the degree of emphasis on primary physician involvement. Moreover, the continuing emphasis on a physician-led medical model may be at odds with developing a public health approach which emphasises participative and collaboration with local populations and other primary care providers--an area where physicians have little experience.

Public health. The missing link.

The government's strategy for public health may fail because of a lack of co-operation between organisations. Primary care, as presently constituted, has little energy to take on public health. The strategy places too much stress on the role of health authorities and too little on primary care and local communities. The predominance of the medical model in public health needs to be addressed.