A systematic review of the effectiveness of community-based interventions aimed at improving health literacy of parents/carers of children.

AIM: The aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents. METHODS: A systematic review of six databases - MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source - was conducted to identify relevant articles. Risk of bias was assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane collaboration risk of bias in non-randomised studies of interventions. The study findings were grouped and synthesised following the synthesis without meta-analysis framework. RESULTS: Eleven community-based health literacy interventions for parents were identified. Study design included randomised controlled trials (n = 4), non-randomised studies with comparison group (n = 4), and non-randomised studies without a comparison group (n = 3). Interventions were delivered digitally, in person or a combination of the two. The risk of bias was high in over half the studies (n = 7). The main findings of the studies showed some potential for both in person and digital interventions to increase parental health literacy. Studies were heterogeneous preventing a meta-analysis. CONCLUSION: Community-based, health literacy interventions have been identified as potential methods for enhancing parental health literacy. Due to the small number of included studies and their potential for bias, these results must be interpreted with caution. This study emphasises the need for additional theory and evidence-based research on the long-term effects of community interventions.

Accessibility and applicability of physical activity guidelines and recommendations for adults living with long term conditions during COVID-19.

To review the applicability and accessibility of physical activity guidelines for adults living with long-term conditions whilst shielding during the COVID-19. A narrative review with systematic methodology was conducted between 2015 and 2021, with two stages: 1) Search of electronic databases PubMed/Medline, Web of Science, PsycInfo, and Cinahl; 2) search of long-term condition organisations. Sixty-five articles were identified, where nine included specific guidelines during the COVID-19, 28 specific guidelines to individuals living with long-term conditions and 7 identified the utilization of online resources. Twenty-one long-term condition organizations websites were reviewed where all of them included a section regarding physical activity guidelines and seven referred to online and offline accessible resources during COVID-19. Accessibility and applicability were variable across academic databases and long-term conditions organisation websites. Findings could inform long-term condition policy and guidelines development to better and more relevant support people living with long-term conditions to be physically active.

P-FLUX: A phosphorus budget dataset spanning diverse agricultural production systems in the United States and Canada.

Quantifying spatial and temporal fluxes of phosphorus (P) within and among agricultural production systems is critical for sustaining agricultural production while minimizing environmental impacts. To better understand P fluxes in agricultural landscapes, P-FLUX, a detailed and harmonized dataset of P inputs, outputs, and budgets, as well as estimated uncertainties for each P flux and budget, was developed. Data were collected from 24 research sites and 61 production systems through the Long-term Agroecosystem Research (LTAR) network and partner organizations spanning 22 U.S. states and 2 Canadian provinces. The objectives of this paper are to (a) present and provide a description of the P-FLUX dataset, (b) provide summary analyses of the agricultural production systems included in the dataset and the variability in P inputs and outputs across systems, and (c) provide details for accessing the dataset, dataset limitations, and an example of future use. P-FLUX includes information on select site characteristics (area, soil series), crop rotation, P inputs (P application rate, source, timing, placement, P in irrigation water, atmospheric deposition), P outputs (crop removal, hydrologic losses), P budgets (agronomic budget, overall budget), uncertainties associated with each flux and budget, and data sources. Phosphorus fluxes and budgets vary across agricultural production systems and are useful resources to improve P use efficiency and develop management strategies to mitigate environmental impacts of agricultural systems. P-FLUX is available for download through the USDA Ag Data Commons (https://doi.org/10.15482/USDA.ADC/1523365).

Establishing and integrating a transoral robotic surgery programme into routine oncological management of head and neck cancer - a UK perspective.

BACKGROUND: The introduction of transoral robotic surgery into routine management of patients is complex. It involves organisational, logistical and clinical challenges. This study presents our experience of implementing such a programme and provides a blueprint for other centres willing to establish similar services. METHODS: Implementation of the robotic surgery programme focused on several key domains: training, logistics, governance, multidisciplinary team awareness, pre-operative imaging, anaesthesia, post-operative care, finance, patient selection and consent. Programme outcomes were evaluated by assessing operative outcomes of the first 117 procedures performed. RESULTS: The success of the transoral robotic surgery programme has been possible because of the scrupulous planning phase before the first procedure, and the time invested on team awareness and training. CONCLUSION: Implementation of a new transoral robotic surgery service has led to: the development of a dedicated transoral robotic surgery patient care protocol, the performance of progressively more complex procedures, the inclusion of transoral robotic surgery training and the establishment of several research projects.

Comparing the outcomes of external oblique and transversus abdominus release using the AHSQC database.

PURPOSE: Myofascial release techniques at the time of complex hernia repair allow for tension-free closure of the midline fascia. Two common techniques are the open external oblique release (EOR) and the transversus abdominis release (TAR). Each technique has its reported advantages and disadvantages, but there have been few comparative studies. The purpose of this project was to compare the outcomes of these two myofascial release techniques. METHODS: The Americas Hernia Society Quality Collaborative (AHSQC) database was queried and produced a data set on 24 May 2018. All patients undergoing open incision hernia repair with an open EOR or TAR were evaluated, and outcomes were compared including hernia recurrence, quality of life, and 30-day wound-related complications. RESULTS: 3610 patients met the inclusion criteria of undergoing open incisional hernia repair (501 undergoing EOR and 3109 undergoing TAR). Seventy surgeons from 50 institutions contributed EOR patients, and 124 surgeons from 89 institutions contributed TAR patients with no differences between the two groups in surgeons' affiliation. Comparing open EOR and TAR showed no significant differences in hernia recurrence, quality of life, or 30-day surgical site infection rate. EOR had a significantly higher rate of surgical site occurrences compared with TAR (p < 0.05); however, this did not result in an increase in surgical site occurrences requiring procedural interventions. CONCLUSIONS: Equivalent outcomes were achieved using the EOR or TAR techniques in the open repair of incisional hernias. Both techniques offer consistently good outcomes and are important adjuncts in the repair of complex incisional hernias.

Author Correction: Inhibition of casein kinase 1δ/εimproves cognitive-affective behavior and reduces amyloid load in the APP-PS1 mouse model of Alzheimer's disease.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Inhibition of casein kinase 1δ/εimproves cognitive-affective behavior and reduces amyloid load in the APP-PS1 mouse model of Alzheimer's disease.

Circadian rhythm disruption is one of the earliest biomarkers of Alzheimer's disease (AD), and there exists a bidirectional relationship by which dysfunctions in the circadian clock drive AD pathology and AD pathology drives circadian dysfunction. Casein kinase 1 (CK1) isoforms ε and δ, key circadian regulators, are significantly upregulated in AD and may contribute to AD pathogenesis. In the current studies, we have examined how inhibition of CK1ε/δ with PF-670462 (at 10 mg/kg, δ isoform selective, or 30 mg/kg, δ and ε selective) impacts regional Aß and circadian gene expression in 10-13 month old APP-PS1 mice and nontransgenic controls. We have also assessed circadian, cognitive, and affective behavioral correlates of these neural changes. At baseline, APP-PS1 mice showed a short period, as well as impaired cognitive performance in both prefrontal cortex and hippocampus-dependent tasks. Both doses of PF-670462 lengthened the period and improved affect, whereas only the higher dose improved cognition. Further, PF-670462 treatment produced a dose-dependent reduction in amyloid burden - overall Aß signal decreased in all three areas; in the prefrontal cortex and hippocampus, PF-670462 also reduced plaque size. Together, these findings support chronotherapy as a potential tool to improve behavior in AD.

The effects of 4 weeks normobaric hypoxia training on microvascular responses in the forearm flexor.

Intermittent exposure to hypoxia can lead to improved endurance performance. Currently, it is unclear whether peripheral adaptions play a role in improving oxygen delivery and utilization following both training and detraining. This study aimed to characterize skeletal muscle blood flow (mBF), oxygen consumption (mV̇O2), and perfusion adaptations to i) 4-weeks handgrip training in hypoxic and normoxic conditions, and ii) following 4-weeks detraining. Using a randomised crossover design, 9 males completed 30-min handgrip training four times a week in hypoxic (14% FiO2 ~ 3250m altitude) and normoxic conditions. mBF, mV̇O2 and perfusion were assessed pre, post 4-weeks training, and following 4-weeks detraining. Hierarchical linear modelling found that mV̇O2 increased at a significantly faster rate (58%) with hypoxic training (0.09 mlO2·min-1 · 100g-1 per week); perfusion increased at a significantly (69%) faster rate with hypoxic training (3.72 µM per week). mBF did not significantly change for the normoxic condition, but there was a significant increase of 0.38 ml· min-1 · 100ml-1 per week (95% CI: 0.35, 0.40) for the hypoxic condition. During 4-weeks detraining, mV̇O2 and perfusion significantly declined at similar rates for both conditions, whereas mBF decreased significantly faster following hypoxic training. Four weeks hypoxic training increases the delivery and utilisation of oxygen in the periphery.

The efficacy of a discontinuous graded exercise test in measuring peak oxygen uptake in children aged 8 to 10 years.

As children's natural activity patterns are highly intermittent in nature, and characterised by rapid changes from rest to vigorous physical activity, discontinuous exercise tests may be considered ecologically valid for this population group. This study compared the peak physiological responses from a discontinuous and continuous graded exercise test (GXT_D, GXT_C, respectively) during treadmill exercise in children. Twenty-one healthy children (9.6 ± 0.6 y) completed GXT_D and GXT_C in a randomised order, separated by 72-hours. Following each GXT, and after a 15-minute recovery, participants completed a verification test at 105% of the velocity attained at peak oxygen consumption (VO2peak). There were no differences in VO2peak (55.3 ± 8.2 cf. 54.4 ± 7.6 mL·kg-1·min-1) or maximal heart rate (202 ± 10 cf. 204 ± 8 b·min-1) between GXT_C and GXT_D, respectively (P>.05). Peak running speed (10.7 ± 0.9 cf. 12.1 ± 1.3 km·h-1) and respiratory exchange ratio (1.04 ± 0.05 cf. 0.92 ± 0.05) were however different between tests (P<.001). Although similar peak physiological values were revealed between GXT_C and the corresponding verification test (P>.05), VO2peak (53.3 ± 7.3 mL·kg-1·min-1) and heart rate (197 ± 13 b·min-1) were significantly lower in the GXT_D verification test (P<.05). In conclusion, a discontinuous GXT is an accurate measure of VO2peak in children aged 8 to 10 years and may be a valid alternative to a continuous GXT, despite its longer duration.

Effect of an acute dose of omega-3 fish oil following exercise-induced muscle damage.

PURPOSE: The purpose of this double-blind, placebo-controlled study was to examine the effect of two fish oil supplements, one high in EPA (750 mg EPA, 50 mg DHA) and one low in EPA (150 mg EPA, 100 mg DHA), taken acutely as a recovery strategy following EIMD. METHODS: Twenty-seven physically active males (26 ± 4 year, 1.77 ± 0.07 m, 80 ± 10 kg) completed 100 plyometric drop jumps to induce muscle damage. Perceptual (perceived soreness) and functional (isokinetic muscle strength at 60° and 180° s-1, squat jump performance and countermovement jump performance) indices of EIMD were recorded before, and 1, 24, 48, 72, and 96h after the damaging protocol. Immediately after the damaging protocol, volunteers ingested either a placebo (Con), a low-EPA fish oil (Low EPA) or a high-EPA fish oil (High EPA) at a dose of 1 g per 10 kg body mass. RESULTS: A significant group main effect was observed for squat jump, with the High EPA group performing better than Con and Low EPA groups (average performance decrement, 2.1, 8.3 and 9.8%, respectively), and similar findings were observed for countermovement jump performance, (average performance decrement, 1.7, 6.8 and 6.8%, respectively, p = 0.07). Significant time, but no interaction main effects were observed for all functional and perceptual indices measured, although large effect sizes demonstrate a possible ameliorating effect of high dose of EPA fish supplementation (effect sizes ≥0.14). CONCLUSION: This study indicates that an acute dose of high-EPA fish oil may ameliorate the functional changes following EIMD.

A randomized controlled trial to assess the central hemodynamic response to exercise in patients with transient ischaemic attack and minor stroke.

Early exercise engagement elicits meaningful changes in peripheral blood pressure in patients diagnosed with transient ischaemic attack (TIA) or minor stroke. However, central hemodynamic markers may provide clinicians with important diagnostic and prognostic information beyond that provided by peripheral blood pressure readings. The purpose of this single-centre, randomized, parallel-group clinical trial was to determine the effect of a 12-week aerobic exercise intervention on central and peripheral hemodynamic variables in patients with TIA or minor stroke. In this study, 47 participants (66±10 years) completed a baseline assessment, which involved the measurement of central and peripheral hemodynamic parameters, undertaken in the morning, in a fasted state. Participants were randomized to either a 12-week exercise or control group on completion of the baseline assessment. An identical follow-up assessment was completed post intervention. Central hemodynamic variables were assessed using an oscillometric device at both assessments. Analysis of covariance demonstrated a significant interaction for central and peripheral blood pressure and augmentation index (all P<0.05; ηp2.09-.11), with the exercise group presenting lower values than the control group post intervention (118±17 vs 132±28 mm Hg for central blood pressure; 125±19 vs 138±28 mm Hg for peripheral blood pressure; 104±49 vs 115±67% for augmentation index). The present study demonstrates that participation in an exercise program soon after stroke/TIA diagnosis may elicit significant beneficial changes to a patient's central systolic blood pressure and augmentation index. This may positively impact upon the treatment strategies implemented by clinicians in the care of patients with TIA and minor stroke.

The effect of trial familiarisation on the validity and reproducibility of a field-based self-paced VO2max test.

The self-paced maximal oxygen uptake (VO2max) test (SPV), which is based on the Borg 6-20 Ratings of Perceived Exertion (RPE) scale, allows participants to self-regulate their exercise intensity during a closed-loop incremental maximal exercise test. As previous research has assessed the utility of the SPV test within laboratory conditions, the purpose to this study was to assess the effect of trial familiarisation on the validity and reproducibility of a field-based, SPV test. In a cross-sectional study, fifteen men completed one laboratory-based graded exercise test (GXT) and three field-based SPV tests. The GXT was continuous and incremental until the attainment of VO2max. The SPV, which was completed on an outdoor 400m athletic track, consisted of five x 2 min perceptually-regulated (RPE11, 13, 15, 17 and 20) stages of incremental exercise. There were no differences in the VO2max reported between the GXT (63.5±10.1 ml·kg(-1)·min(-1)) and each SPV test (65.5±8.7, 65.4±7.0 and 66.7±7.7 ml·kg(-1)·min(-1) for SPV1, SPV2 and SPV3, respectively; P>.05). Similar findings were observed when comparing VO2max between SPV tests (P>.05). High intraclass correlation coefficients were reported between the GXT and the SPV, and between each SPV test (≥.80). Although participants ran faster and further during SPV3, a similar pacing strategy was implemented during all tests. This study demonstrated that a field-based SPV is a valid and reliable VO2max test. As trial familiarisation did not moderate VO2max values from the SPV, the application of a single SPV test is an appropriate stand-alone protocol for gauging VO2max.

The chemokine receptor CCR7 promotes mammary tumorigenesis through amplification of stem-like cells.

The chemokine receptor CCR7 is widely implicated in breast cancer pathobiology. Although recent reports correlated high CCR7 levels with more advanced tumor grade and poor prognosis, limited in vivo data are available regarding its specific function in mammary gland neoplasia and the underlying mechanisms involved. To address these questions we generated a bigenic mouse model of breast cancer combined with CCR7 deletion, which revealed that CCR7 ablation results in a considerable delay in tumor onset as well as significantly reduced tumor burden. Importantly, CCR7 was found to exert its function by regulating mammary cancer stem-like cells in both murine and human tumors. In vivo experiments showed that loss of CCR7 activity either through deletion or pharmacological antagonism significantly decreased functional pools of stem-like cells in mouse primary mammary tumors, providing a mechanistic explanation for the tumor-promoting role of this chemokine receptor. These data characterize the oncogenic properties of CCR7 in mammary epithelial neoplasia and point to a new route for therapeutic intervention to target evasive cancer stem cells.

Effect of early exercise engagement on arterial stiffness in patients diagnosed with a transient ischaemic attack.

This study investigated the effects of regular exercise participation on common carotid artery stiffness in patients recently diagnosed with transient ischaemic attack (TIA). A total of 21 male and 4 female participants (mean±s.d.; 66±12 years, 1.72±0.07 m, 85.5±12.4 kg), recruited within 2 weeks of TIA diagnosis, completed a risk stratification assessment (including fasting blood glucose, cholesterol), a health history questionnaire and underwent measures of arterial stiffness (compliance and distensibility). Participants were then randomized to either an exercise (EX; 8-week intervention) or a usual-care control (CON) condition. Identical measures were obtained post intervention. Within-subject, repeated measures analysis of variance, with Condition as the between-subject factor (EX and CON), was used to assess measures of arterial stiffness at the baseline and postintervention assessment. Results revealed a significant interaction whereby an increase in compliance (0.71±0.24 vs. 0.83±0.28 mm2 kPa(-1), P=0.048, partial η2=0.159) and distensibility (15.98±5.95 vs. 19.49±6.60 10(-3) kPa(-1), P=0.023, partial η2=0.204) was observed for EX but not for CON. The present study has demonstrated that engagement in exercise soon after TIA diagnosis leads to improved large artery health. These improvements in vascular health may reduce the risk of an ensuing or recurring cardio- or cerebrovascular event.

The single-site Green's function and Krein's theorem.

An important step in electronic structure calculations using multiple-scattering theory is obtaining the density of states for the central site from the Green's function for that site. We have found that the Krein's spectral displacement function for the central site contributes significantly to the understanding of these calculations. We argue that these insights can lead to improvements in the robustness of MST electronic structure codes without negatively impacting their performance.

The effect of a short-term exercise programme on haemodynamic adaptability; a randomised controlled trial with newly diagnosed transient ischaemic attack patients.

This study assessed the effect of a short-term, 8-week exercise programme on resting and exercise blood pressure (systolic (SBP); diastolic (DBP)), and other haemodynamic responses (heart rate (HR), pulse pressure (PP), double product (DP)), of newly diagnosed transient ischaemic attack (TIA) patients. Sixty-eight TIA patients completed a continuous and incremental exercise test within 2 weeks of symptom diagnosis. HR, SBP and DBP were regularly measured at rest, during exercise and in recovery. Participants were then randomised to either an 8-week exercise programme or to a usual care control group prior to completing an identical post-intervention (PI) re-assessment. Individuals randomised to the exercise condition experienced a significantly greater reduction in resting HR (-5.4±10.2%), SBP (-6.7±8.1%) and DBP (-2.8±7.2%) than the control group at the PI assessment (all P<0.05). Similar findings were demonstrated at the PI assessment when comparing haemodynamic responses during exercise (P<0.05), with significantly larger decrements observed for SBP and HR (both 10-14%), PP (17-24%) and DP (26-32%) for those randomised to the exercise intervention (all P<0.05). This study demonstrates that structured physical activity soon after TIA diagnosis will improve haemodynamic responses. The early implementation of exercise following TIA diagnosis may be an important secondary prevention strategy for this population.

Natural outbreak of Streptococcus agalactiae (GBS) infection in wild giant Queensland grouper, Epinephelus lanceolatus (Bloch), and other wild fish in northern Queensland, Australia.

Ninety-three giant Queensland grouper, Epinephelus lanceolatus (Bloch), were found dead in Queensland, Australia, from 2007 to 2011. Most dead fish occurred in northern Queensland, with a peak of mortalities in Cairns in June 2008. In 2009, sick wild fish including giant sea catfish, Arius thalassinus (Rüppell), and javelin grunter, Pomadasys kaakan (Cuvier), also occurred in Cairns. In 2009 and 2010, two disease epizootics involving wild stingrays occurred at Sea World marine aquarium. Necropsy, histopathology, bacteriology and PCR determined that the cause of deaths of 12 giant Queensland grouper, three wild fish, six estuary rays, Dasyatis fluviorum (Ogilby), one mangrove whipray, Himantura granulata (Macleay), and one eastern shovelnose ray, Aptychotrema rostrata (Shaw), was Streptococcus agalactiae septicaemia. Biochemical testing of 34 S. agalactiae isolates from giant Queensland grouper, wild fish and stingrays showed all had identical biochemical profiles. The 16S rRNA gene sequences of isolates confirmed all isolates were S. agalactiae; genotyping of selected S. agalactiae isolates showed the isolates from giant Queensland grouper were serotype Ib, whereas isolates from wild fish and stingrays closely resembled serotype II. This is the first report of S. agalactiae from wild giant Queensland grouper and other wild tropical fish and stingray species in Queensland, Australia.