The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review.

OBJECTIVE: To examine the effectiveness of interventions using the World Health Organization Health Promoting Schools (HPSs) framework approach in increasing physical activity (PA) and improving the diet of 11-18-year-olds. STUDY DESIGN: A systematic review guided by the National Health Services Centre for Reviews and Dissemination framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. METHODS: Nine databases and trial registries were searched from 2013 to 2018 for cluster randomised controlled trials involving adolescents' aged 11-18 years. We also included relevant studies from a 2014 Cochrane Review of HPS approach on health behaviours. Data were extracted from included studies and assessed for quality. RESULTS: Twelve eligible studies were identified from seven countries. The studies varied in outcome measures, sample size, quality and duration of intervention and follow-up. Only four of the included studies were of high to moderate quality. We found some evidence of effectiveness for physical activity only interventions and limited evidence of effectiveness for nutrition only and combined PA and nutrition interventions. CONCLUSIONS: There were no discernible patterns across the studies to suggest effective mechanisms for the HPS approach. The family/community component was poorly developed and superficially reported in all studies. Future research should seek to understand how best to work in partnership with secondary schools, to foster and sustain a healthy eating and physical activity culture, which aligns with their core aims. More attention should be paid to the restriction of unhealthy foods in the school environment.

First Direct Measurements of Superheavy-Element Mass Numbers.

An experiment was performed at Lawrence Berkeley National Laboratory's 88-in. Cyclotron to determine the mass number of a superheavy element. The measurement resulted in the observation of two α-decay chains, produced via the ^{243}Am(^{48}Ca,xn)^{291-x}Mc reaction, that were separated by mass-to-charge ratio (A/q) and identified by the combined BGS+FIONA apparatus. One event occurred at A/q=284 and was assigned to ^{284}Nh (Z=113), the α-decay daughter of ^{288}Mc (Z=115), while the second occurred at A/q=288 and was assigned to ^{288}Mc. This experiment represents the first direct measurements of the mass numbers of superheavy elements, confirming previous (indirect) mass-number assignments.

Urinary tract infection caused by Lactococcus garvieae in a premature neonate: A case report.

Lactococcus garvieae is a gram-positive cocci that has primarily been described as a pathogen in various fish species, but has increasingly been reported to cause endocarditis and other infections in humans [1]. Neonatal infection caused by Lactococcus garvieae has not been previously reported. Here we describe a premature neonate who developed a urinary tract infection with this organism and was successfully treated with vancomycin therapy.

Psychological resilience in young and older adults.

BACKGROUND: The goal of the current study was to investigate psychological resilience in the older adults (>64 years) compared with that of the young ones (<26 years). METHODS: Questionnaire measures of depression, hopelessness, general health and resilience were administered to the participants. The resilience measure comprised three sub-scales of social support, emotional regulation and problem solving. RESULTS: The older adults were the more resilient group especially with respect to emotional regulation ability and problem solving. The young ones had more resilience related to social support. Poor perceptions of general health and low energy levels predicted low levels of resilience regardless of age. Low hopelessness scores also predicted greater resilience in both groups. Experiencing higher levels of mental illness and physical dysfunction predicted high resilience scores especially for the social support resilience scale in the older adults. The negative effects of depression on resilience related to emotional regulation were countered by low hopelessness but only in the young adults. CONCLUSIONS: These results highlight the importance of maintaining resilience-related coping skills in both young and older adults but indicate that different psychological processes underlie resilience across the lifespan.

Outbreak of Newcastle disease due to pigeon paramyxovirus type 1 in grey partridges (Perdix perdix) in Scotland in October 2006.

In October 2006, following an initially non-statutory disease investigation affecting 12-week-old grey partridges (Perdix perdix), an outbreak of Newcastle disease due to infection with the avian paramyxovirus type 1 virus responsible for the current panzootic in pigeons (PPMV-1) was confirmed in Scotland. Two pens of partridges were affected by signs including loss of condition, diarrhoea, progressive neurological signs and mortality totalling approximately 24 per cent, and laboratory evidence of the infection was obtained only in these groups. The premises had approximately 17,000 poultry including a collection of 375 birds of rare breeds, containing endangered breeds of significant conservation value, which were not culled but subjected to a health monitoring and testing programme. Investigations suggested that a population of feral pigeons living above the affected pens of partridges was the likely source of the outbreak. Laboratory and genetic analyses confirmed that the isolate recovered from the clinically affected partridges was PPMV-1, belonging to genetic lineage 4b. However, the virus could not be isolated from or detected in dead pigeons collected from the affected buildings.

On the selection of endogenous and exogenous signals.

Alerting is one of the three components of attention which involves the eliciting and maintenance of arousal. A seminal study by Posner et al. (Posner MI, Klein R, Summers J, Buggie S. 1973 Mem. Cognit. 1, 2-12 (doi:10.3758/BF03198062)) focused on how changing the interval between an alerting signal and a target would impact the speed and accuracy of responding. Participants indicated whether targets were presented on the left or right side of the fixation point. Auditory warning signals were played at various intervals prior to the target to alert participants and prepare them to make a response. Reaction times revealed a robust, U-shaped, preparation function. Importantly, a clear speed-accuracy trade-off (SAT) was observed. In the current experiment, we replicated the methodological components of this seminal study while implementing a novel auditory warning signal (Lawrence MA, Klein RM. 2013 J. Exp. Psychol. General 142, 560 (doi:10.1037/a0029023)) that was either purely endogenous (change in quality without a change in intensity; analogous to isoluminant colour change in vision) or a combination of endogenous and exogenous (change in both quality and intensity). We expected to replicate the U-shaped preparation function and SAT observed by Posner and colleagues. Based on Lawrence and Klein's findings we also expected the SAT to be more robust with the intense signal in comparison to the isointense signal.

Transmission microscopy without lenses for objects of unlimited size.

We demonstrate experimentally, for the first time, a new form of lensless microscopy. The image we obtain contains the entire wavefunction emanating from the sample. Large scale, quantitative phase information can be measured, unlike in conventional (Zernike) methods. For light optical experiments, we can dispense with expensive high-quality lenses and the very large working distances available would allow remote monitoring of e.g., environmental cells without compromising resolution. In short wavelength microscopy (X-rays and electrons), where lens components are of very limited numerical aperture, the technique has revolutionary implications: objects of any lateral size or shape can be used and, for transmission electron imaging, resolution down to the scale of the wavelength is likely to be limited only by the presence of atomic vibrations.

Basic properties and potential regulators of the apical K+ channel in macula densa cells.

These studies examine the properties of an apical potassium (K+) channel in macula densa cells, a specialized group of cells involved in tubuloglomerular feedback signal transmission. To this end, individual glomeruli with thick ascending limbs (TAL) and macula densa cells were dissected from rabbit kidney and the TAL covering macula densa cells was removed. Using patch clamp techniques, we found a high density (up to 54 channels per patch) of K+ channels in the apical membrane of macula densa cells. An inward conductance of 41.1 +/- 4.8 pS was obtained in cell-attached patches (patch pipette, 140 mM K+). In inside-out patches (patch pipette, 140 mM; bath, 5 mM K+), inward currents of 1.1 +/- 0.1 pA (n = 11) were observed at 0 mV and single channel current reversed at a pipette potential of -84 mV giving a permeability ratio (PK/PNa) of over 100. In cell-attached patches, mean channel open probability (N,Po, where N is number of channels in the patch and Po is single channel open probability) was unaffected by bumetanide, but was reduced from 11.3 +/- 2.7 to 1.6 +/- 1.3 (n = 5, p < 0.02) by removal of bath sodium (Na+). Simultaneous removal of bath Na+ and calcium (Ca2+) prevented the Na(+)-induced decrease in N.Po indicating that the effect of Na+ removal on N.Po was probably mediated by stimulation of Ca2+ entry. This interpretation was supported by studies where ionomycin, which directly increases intracellular Ca2+, produced a fall in N.Po from 17.8 +/- 4.0 to 5.9 +/- 4.1 (n = 7, p < 0.02). In inside-out patches, the apical K+ channel was not sensitive to ATP but was directly blocked by 2 mM Ca2+ and by lowering bath pH from 7.4 to 6.8. These studies constitute the first single channel observations on macula densa cells and establish some of the characteristics and regulators of this apical K+ channel. This channel is likely to be involved in macula densa transepithelial Cl- transport and perhaps in the tubuloglomerular feedback signaling process.

N-Acetylprocainamide kinetics and clinical response during repeated dosing.

Kinetics of and clinical responses to N-acetylprocainamide (NAPA) were evaluated in 10 patients with chronic ventricular arrhythmias who had not responded to usual doses of currently available antiarrhythmic drugs. Kinetic data analysis was by measured NAPA concentrations (n = 149) collected during repeated dosing. Response was evaluated with serial 24-hr ambulatory ECGs. An a priori kinetic model based on earlier studies predicted NAPA concentrations well (r = 0.94, SEE = 3.6 mg/l). The capability for defining patient-specific estimates for drug disposition with six or seven serum concentrations measured at the outset of therapy was subsequently confirmed with larger data sets from the same patients. Mean values for elimination rate (0.082 hr -1 +/- 0.017) and volume of distribution (1.25 l/kg +/- 0.28) were of the same order as in earlier single-dose studies. A substantial degree of interpatient and intrapatient variability in the absorption rate for NAPA was observed. NAPA was not found to be clinically effective in any of the 10 patients, although two patients demonstrated a greater than 70% reduction in frequency of premature ventricular contractions. There were adverse effects in all patients, which frequently required dose reduction or cessation of therapy. In this group of patients with resistant arrhythmias, NAPA was no more effective than baseline therapy, and adverse effects often limited complete evaluation. The kinetic analysis demonstrated the feasibility of a strategy for developing patient-specific kinetic models that may have applications to other antiarrhythmic drugs.

Plasma cyclic guanosine monophosphate in chronic heart failure: hemodynamic and neurohormonal correlations and response to nitrate therapy.

This study evaluated the relation between plasma cyclic guanosine monophosphate (cGMP) and hemodynamic and neurohormonal parameters in patients with chronic congestive heart failure and assessed the effect of organic nitrate on plasma cGMP levels. Plasma cGMP was fourfold higher in 18 patients with congestive heart failure compared with 15 control subjects (16.7 +/- 9.7 versus 4.0 +/- 1.0 pmol/ml; p < 0.0001) but did not correlate with plasma levels of catecholamines, renin, atrial natriuretic peptide, or with baseline hemodynamic values. The administration of a hemodynamically effective dose of oral isosorbide dinitrate (40 mg) resulted in a transient reduction in plasma cGMP from 16.7 +/- 9.7 pmol/ml at baseline to 13.0 +/- 6.6 pmol/ml at 1 hour (p < 0.05). This change was associated with small and statistically insignificant changes in neurohormonal values and had no relation to any of the hemodynamic changes. We concluded that (1) elevated plasma cGMP in congestive heart failure does not correlate with other neurohormonal or hemodynamic parameters and may be an independent parameter of heart failure, (2) in contrast to previously documented nitrate-mediated increases in intracellular cGMP, nitrate therapy results in a reduction in plasma cGMP, and (3) changes in plasma cGMP cannot serve as a surrogate measurement of changes in intracellular cGMP.

Risks of angiotensin-converting enzyme inhibition during pregnancy: experimental and clinical evidence, potential mechanisms, and recommendations for use.

OBJECTIVE: To review reports on the use of angiotensin-converting enzyme inhibitors (ACE-I) during pregnancy in order to determine the incidence, nature, and potential mechanisms of fetal complications in an attempt to establish recommendations related to the use of these drugs during gestation. DATA SOURCES: Relevant English-language articles identified through a Medline search and bibliographies found in recent articles. STUDY SELECTION: Large number of reports both on animals and on humans have consistently shown a high degree of morbidity and even mortality in fetuses or newborns exposed to ACE-I during pregnancy. The reported complications include oligohydramnios, intrauterine growth retardation, premature labor, fetal and neonatal renal failure, bony malformations, limb contractures, persistent patent ductus arteriosus, pulmonary hypoplasia, respiratory distress syndrome, prolonged hypotension, and neonatal death. A high incidence of fetal complications was related to the use of ACE-I at all trimesters of pregnancy. CONCLUSION: The gestational use of ACE-I may be associated with a high degree of fetal and newborn morbidity and even mortality. The use of these drugs should be avoided at all trimesters of pregnancy.

Individualising gentamicin dosage regimens. A comparative review of selected models, data fitting methods and monitoring strategies.

The various components required for individualising clinical drug dosage regimens are reviewed, including a study of 3 types of fitting procedures, 2 types of gentamicin pharmacokinetic model and the utility of D-optimal times for obtaining serum gentamicin concentrations. The combination of the current Bayesian fitting procedure, the kslope pharmacokinetic model [in which the elimination rate constant (kel) can change from dose to dose with changing creatinine clearance] and the explicit measurement of the assay error pattern yielded predictions of future serum gentamicin concentrations which were (a) slightly better than those found using weighted nonlinear least squares; (b) somewhat better than those found with Bayesian fitting and a fixed-kel model; (c) better than those found using the traditional linear regression fitting procedure and a fixed kel model. D-Optimally timed pairs of concentrations also predicted future concentrations at least as well, and more cost effectively.

An analysis of closed obstetric malpractice claims.

We reviewed all closed obstetric claims in the records of a major physician-sponsored malpractice insurer that has written policies from 1982 to the present. Of the 54 files closed during the 6.5-year period covered by this study, 21 (39%) involved physician reports of bad outcomes that did not lead to a formal claim. Of the 33 formal claims, 14 (42%) were dismissed, either by the plaintiff's attorney or by the courts. Eighteen of the remaining 19 claims were settled before trial, with an average payment to the plaintiff of $185,000. The one suit that went to trial resulted in a defense verdict. A review of the case histories demonstrated that in the majority of cases when a payment was made, probable medical negligence had taken place. Non-meritorious claims were not compensated. For those cases in which a payment was made, the size of the settlement was commensurate with the seriousness of the injury, which almost always involved damage to the infant. Poor physician judgment was the most common source of error.

Treatment of recurrent urinary tract infection with norfloxacin versus trimethoprim-sulfamethoxazole.

Norfloxacin, a broad-spectrum antimicrobial analog of nalidixic acid, was evaluated by comparing it to trimethoprim-sulfamethoxazole in 93 office patients with recurrent urinary tract infections. In this prospective randomized study, norfloxacin and trimethoprim-sulfamethoxazole were given on the same dosage schedule with the former drug given as a 400-mg tablet twice daily and the latter drug given as a double strength tablet twice daily. Overall, 50 patients received norfloxacin and 43 patients received trimethoprim-sulfamethoxazole with a cure rate of 96 percent and 79 percent, respectively. Whether a patient had one infection or multiple previous infections, norfloxacin appeared to be superior to trimethoprim-sulfamethoxazole. Only minor side effects were noted in either group, and no patient withdrew from this study as a direct result of these side effects. Minor complaints of nausea, dizziness, and headache were found in the norfloxacin group (24%) and in the trimethoprim-sulfamethoxazole group (16%). Both agents are effective in treating urinary tract infections but norfloxacin is superior to trimethoprim-sulfamethoxazole in patients with either recurrent complicated infections or one previous uncomplicated urinary tract infection.

Nitric-oxide-induced inhibition of glyceraldehyde-3-phosphate dehydrogenase may mediate reduced endothelial cell monolayer integrity in an in vitro model blood-brain barrier.

The process of nitric-oxide (NO)-induced cellular toxicity may involve energy deprivation since the radical is reported to prevent both mitochondrial oxidative phosphorylation and glycolysis. In order to determine whether these processes are important in NO-induced blood-brain barrier (BBB) dysfunction, we used a cell culture model of the BBB and compared the effects of gaseous NO, potassium cyanide (KCN, a mitochondrial respiratory chain inhibitor) and iodoacetate [IA, an inhibitor of the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (GAPDH)] on endothelial cell ATP content, GAPDH activity and barrier integrity. NO lead to a rapid breakdown in model barrier integrity and resulted in a reduction in endothelial cell ATP content and GAPDH activity. KCN had no effect on endothelial cell ATP content or barrier integrity, while IA, at a concentration that completely blocked endothelial cell GAPDH activity, resulted in a rapid decline in ATP content but did not lead to a decline in barrier integrity until at least 2 h of exposure. These results indicate that inhibition of endothelial cell GAPDH activity rather than mitochondrial respiration causes an energy deficiency and delayed barrier dysfunction. However, the rapid detrimental effects of gaseous NO on barrier integrity cannot be fully explained by endothelial cell energy depletion and may be related to the actions of the free radical and its products on cellular lipids.

Pharmacokinetic and pharmacodynamic evaluation of atenolol during and after pregnancy.

STUDY OBJECTIVE: To evaluate changes due to pregnancy on atenolol's pharmacokinetics, response of maternal heart rate to atenolol, and the drug's effect on fetal heart rate. DESIGN: Prospective study. SETTING: Large university teaching hospital. PATIENTS: Fourteen pregnant women who were receiving oral atenolol for cardiac disease were enrolled and 10 completed the study. INTERVENTIONS: Patients were studied for 12 hours during the third trimester (TT) and again 6 weeks postpartum (PP). MEASUREMENTS AND MAIN RESULTS: Fetal heart rates, and maternal heart rates at rest and during exercise were recorded. Maternal plasma and urine atenolol concentrations were measured. Average resting heart rates (TT 68+/-10, PP 62+/-9 beats/min) and maximum heart rate during exercise (TT 100+/-6, PP 87+/-7 beats/min) were significantly higher in the third trimester than postpartum (p<0.05). The 12-hour atenolol area under the curve (TT 0.208+/-0.061, PP 0.215+/-0.089 ng/ml/day) and maximum plasma concentrations during the time of exercise tests (TT 1.07+/-0.39, PP 1.14+/-0.53 mmol/L) were not significantly different. Individual and population pharmacokinetics did not differ significantly between study periods. The fetal heart rate did not correlate with maternal atenolol concentration. CONCLUSION: Constant dosages of atenolol result in higher heart rates during pregnancy compared with the postpartum period. This lack of heart rate control is not due to significant changes in atenolol's pharmacokinetics or plasma concentrations.

Efficacy, risks, and limits of extracorporeal shock wave lithotripsy for salivary gland stones.

Stones of the salivary glands may cause recurrent swelling, ascending inflammation, and colic-like pain. Previously, in order to get rid of these stones, the gland usually had to be removed surgically in spite of the associated risks to adjacent structures, especially the facial nerve. We treated 104 salivary gland stones in patients 14 to 78 years old using the Storz Modulith SL 10 lithotripter. Each session (average 3.6 per patient) consisted of 1000 impulses at 2 Hz and 16 to 18 kV. No anesthesia was required. Earplugs were applied to patients being treated for parotid gland stones. With the aid of SWL and drug-induced salivation, 17 (59%) of the patients with parotid gland stones and 42 (56%) of those with submandibular gland stones obtained either total stone clearance or sufficient fragmentation to permit spontaneous passage. Four patients required surgery. The remaining patients are still being treated. The noninvasive SWL for salivary gland stones is noninvasive and painless and has a considerable success rate. It can be performed on an outpatient basis.

The impact of rainstorm events on coagulation and clarifier performance in potable water treatment.

This paper examines turbidity removal at a water treatment works in England that receives raw water which is difficult to treat during certain rainstorm events. Rainstorm events lead to elevated levels of turbidity and organic matter found in river waters. A robustness index based on settled turbidity was used to identify periods and events that adversely affected the treatment process. This coupled with raw water sampling data indicated that a change in nature and an increase in natural organic matter (NOM) concentrations occurred following rainstorm events. Experimental work investigated the effect of temperature and NOM on the coagulation process and the results show how increasing levels of NOM significantly impaired the coagulation of particulate material, leading to an increase in settled turbidity.

Ptychographic electron microscopy using high-angle dark-field scattering for sub-nanometre resolution imaging.

Diffractive imaging, in which image-forming optics are replaced by an inverse computation using scattered intensity data, could, in principle, realize wavelength-scale resolution in a transmission electron microscope. However, to date all implementations of this approach have suffered from various experimental restrictions. Here we demonstrate a form of diffractive imaging that unshackles the image formation process from the constraints of electron optics, improving resolution over that of the lens used by a factor of five and showing for the first time that it is possible to recover the complex exit wave (in modulus and phase) at atomic resolution, over an unlimited field of view, using low-energy (30 keV) electrons. Our method, called electron ptychography, has no fundamental experimental boundaries: further development of this proof-of-principle could revolutionize sub-atomic scale transmission imaging.