C1-C2 sublaminar taping for displaced odontoid synchondrosis fracture in an infant: A case report and novel surgical technique.

Pediatric cervical spine injuries are rare, and the diagnosis and management can be challenging. Surgical intervention has been recommended in unstable odontoid synchondrosis injuries or those that have failed nonoperative measures. However, the literature remains sparse on the operative management of severe injuries due to the low incidence. An 18-month-old female sustained an unstable odontoid synchondrosis fracture from a motor vehicle accident. Due to ongoing instability after initial immobilization in a halo, the decision was made to proceed with surgical management. With the patient positioned prone and neural monitoring throughout, a posterior approach was utilized. Subperiosteal exposure of the C1 posterior arch was performed bilaterally. A spinal fixation band was passed under the right C1 posterior arch, around the C2 spinous process, under the left C1 posterior arch, and finally back under the C2 spinous process. The C1-C2 distraction was reduced using intraoperative imaging, and the sublaminar tape construct was secured and reinforced. The halo was then reattached. Postoperative recovery was complicated by a halo pin-site infection which was treated with oral antibiotics. The halo was removed after 3 months, following a computerized tomography that demonstrated union. X-rays at 6 months revealed anatomical alignment with the union. Surgery is recommended in pediatric odontoid synchondrosis fractures refractory to nonoperative management. Sublaminar taping of C1-C2 with a spinal fixation band has been demonstrated to be an effective surgical technique in the management of an unstable odontoid synchondrosis fracture.

WALES 2021 Active Healthy Kids (AHK) Report Card: The Fourth Pandemic of Childhood Inactivity.

This is the fourth Active Healthy Kids (AHK) Wales Report Card. The 2021 card produced grades on children and young people's physical activity (PA) using pre-COVID-19 data that were not used in previous versions. Eleven quality indicators of PA were graded through expert consensus and synthesis of the best available evidence. Grades were assigned as follows: Overall PA-F; Organised Sport and PA-C; Active Play-C+; Active Transportation-C-; Sedentary Behaviours-F; Physical Fitness-C-; Family and Peer Influences-D+; School-B-; Community and the Built Environment-C; National Government and Policy-C; and Physical Literacy-C-. All but three grades remained the same or decreased from the 2018 AHK-Wales Report Card (Active Play increased from C- to C+; Active Transportation, D+ to C-; Family and Peers, D to D+). This is concerning for children's health and well-being in Wales, particularly given recent evidence that PA has further decreased during the COVID-19 pandemic. The results from the Report Card should be used to inform the decision making of policy makers, practitioners and educators to improve children and young people's PA levels and opportunities and decrease PA inequalities.

Impact of COVID-19-related social restrictions on orthopaedic trauma in a level 1 trauma centre in Sydney: the first wave.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected communities worldwide. This study examines the impact that public health measures to control viral spread have had on orthopaedic trauma presenting to an Australian level 1 trauma centre. We hypothesized that the volume of orthopaedic trauma in the period of social distancing would decrease, and the mechanisms of injury differ, compared to pre-pandemic times. METHODS: We performed a retrospective analysis of patients requiring emergency orthopaedic surgery between 16 March and 21 April 2020 (the period after social distancing and lockdown commenced), and compared it to the group of patients from the same period in 2019. We collected demographic data, as well as injury type, anatomical location, mechanism of injury and surgical logistics. RESULTS: During the COVID-19 period, total emergency operations performed decreased by 15.6% compared to the same period in 2019. Orthopaedic admissions decreased by 30.8%. Demographics of the groups were unchanged. Anaesthetic time decreased, but total time spent in the operating theatre was unchanged. Road trauma comprised a similar proportion of cases overall; however, cycling-related accidents increased significantly, making up 11% of presentations during COVID-19. Sporting injuries, work-related injuries and multi-traumas reduced during the pandemic. CONCLUSION: The impact of COVID-19-related lockdown measures and social distancing on orthopaedic trauma in Australia has been an overall decrease in volume of cases, combined with significant changes in the mechanisms of injury necessitating surgery.

Mobile phone applications and their use in the self-management of Type 2 Diabetes Mellitus: a qualitative study among app users and non-app users.

BACKGROUND: Mobile phone applications (apps) have been shown to successfully facilitate the self-management of chronic disease. This study aims to evaluate firstly the experiences, barriers and facilitators to app usage among people with Type 2 Diabetes Mellitus (T2DM) and secondly determine recommendations to improve usage of diabetes apps. METHODS: Participants were aged ≥ 18 years with a diagnosis of T2DM for ≥ 6 months. Semi-structured phone-interviews were conducted with 16 app and 14 non-app users. Interviews were based on the Technology Acceptance Model, Health Information Technology Acceptance Model (HITAM) and the Mobile Application Rating Scale. Data were analysed using deductive content analysis. RESULTS: Most app-users found apps improved their T2DM self-management and health. The recommendation of apps by health professionals, as well as positive interactions with them, improved satisfaction; however, only a minority of patients had practitioners involved in their app use. All non-app users had never had the concept discussed with them by a health professional. Facilitators to app use included the visual representation of trends, intuitive navigation and convenience (for example, discretion and portability). Barriers to app use were participant's lack of knowledge and awareness of apps as healthcare tools, perceptions of disease severity, technological and health literacy or practical limitations such as rural connectivity. Factors contributing to app use were classified into a framework based on the Health Belief Model and HITAM. Recommendations for future app design centred on educational features, which were currently lacking (e.g. diabetes complications, including organ damage and hypoglycaemic episodes), monitoring and tracking features (e.g. blood glucose level monitoring with trends and dynamic tips and comorbidities) and nutritional features (e.g. carbohydrate counters). Medication reminders were not used by participants. Lastly, participants felt that receiving weekly text-messaging relating to their self-management would be appropriate. CONCLUSIONS: The incorporation of user-centred features, which engage T2DM consumers in self-management tasks, can improve health outcomes. The findings may guide app developers and entrepreneurs in improving app design and usability. Given self-management is a significant factor in glycaemic control, these findings are significant for GPs, nurse practitioners and allied health professionals who may integrate apps into a holistic management plan which considers strategies outside the clinical environment.

Impacts of environmental disturbances on housing prices: A review of the hedonic pricing literature.

The global environment is susceptible to many types of change, including alterations to the world's climate. Climate change has been linked to a host of modifications to the natural environment, including the increasing frequency and severity of disturbances such as pest outbreaks, invasions by non-native species, and wildfire. These in turn pose substantial risks to human wellbeing and health. Estimates of the direct and indirect costs of these events are important prerequisites to well-rounded cost-benefit analyses of preventative or control measures, themselves essential components of appropriate education, policy and management responses. This review brings together the evidence with respect to the impacts of disturbances such as pests, invasive species and wildfire on residential property values as measured using the hedonic pricing method. It demonstrates that whilst most disturbances have the expected negative or an insignificant house price impact, in some cases disturbances can lead to housing price rise. The possible causes and implications of these unanticipated positive price responses are discussed. Broader consequences of all directions of price impact are also considered, in particular for the development and implementation of polices designed to prevent the occurrence or spread of disturbances, or at a minimum mitigate their negative effects.

Innovations in practice: group mindfulness for adolescent anxiety - results of an open trial.

BACKGROUND: Group Mindfulness Therapy (GMT) is a program tailored for adolescents that targets anxiety with mindfulness skills including present moment awareness, mindfulness in everyday life (breathing, eating, walking), body scan, loving-kindness, and self-acceptance. Youth with anxiety may benefit from mindfulness exercises precisely because they learn to redirect their mind, and presumably their attention, away from wandering in the direction of worry and negative self-appraisals and toward greater acceptance of internal states. This open trial assessed the feasibility and initial effectiveness of GMT in a school setting. METHOD: Twelve 6th and 7th grade adolescents with elevated anxiety [Screen for Child Anxiety Disorders (SCARED) ≥ 30] participated in GMT after school. Youth completed measures of anxiety and perceived stress and their parents completed measures of internalizing and externalizing behavior problems at pretreatment and posttreatment. We hypothesized that GMT would significantly reduce youth anxiety and stress. RESULTS: Significant improvements were observed in anxiety, internalizing, stress, and attention, with effect sizes ranging from .88 to 1.34. CONCLUSIONS: We demonstrate that GMT is feasible and acceptable to adolescents presenting with anxiety as a primary concern. We provide further support for the use of a mindfulness-based intervention for anxiety reduction. The group format suggests a cost-effective way to deliver services in a school setting.

A Bayesian approach to analyzing phenotype microarray data enables estimation of microbial growth parameters.

Biolog phenotype microarrays (PMs) enable simultaneous, high throughput analysis of cell cultures in different environments. The output is high-density time-course data showing redox curves (approximating growth) for each experimental condition. The software provided with the Omnilog incubator/reader summarizes each time-course as a single datum, so most of the information is not used. However, the time courses can be extremely varied and often contain detailed qualitative (shape of curve) and quantitative (values of parameters) information. We present a novel, Bayesian approach to estimating parameters from Phenotype Microarray data, fitting growth models using Markov Chain Monte Carlo (MCMC) methods to enable high throughput estimation of important information, including length of lag phase, maximal "growth" rate and maximum output. We find that the Baranyi model for microbial growth is useful for fitting Biolog data. Moreover, we introduce a new growth model that allows for diauxic growth with a lag phase, which is particularly useful where Phenotype Microarrays have been applied to cells grown in complex mixtures of substrates, for example in industrial or biotechnological applications, such as worts in brewing. Our approach provides more useful information from Biolog data than existing, competing methods, and allows for valuable comparisons between data series and across different models.

Exploring midwives' perception of confidence around facilitating water birth in Western Australia: A qualitative descriptive study.

OBJECTIVE: the option of labouring and/or birthing immersed in warm water has become widely available throughout hospitals in the United Kingdom and Europe over the last two decades. The practice, which also occurs in New Zealand and interstate in Australia, has until recently only been available in Western Australia for women birthing at home with a small publically funded Community Midwifery Program. Despite its popularity and acceptance elsewhere, birth in water has only recently become an option for women attending some public health services in Western Australia. The Clinical Guidelines developed for the local context that support water birth require that the midwives be confident and competent to care for these women. The issue of competency can be addressed with relative ease by maternity care providers; however confidence is rather more difficult to teach, foster and attain. Clinical confidence is an integral element of clinical judgement and promotes patient safety and comfort. For this reason confident midwives are an essential requirement to support the option of water birth in Western Australia. The aim of this study was to capture midwives' perceptions of becoming and being confident in conducting water birth in addition to factors perceived to inhibit and facilitate the development of that confidence. DESIGN: a modified grounded theory methodology with thematic analysis. SETTINGS: four public maternity services offering the option of water birth in the Perth metropolitan area. PARTICIPANTS: registered midwives employed at one of the four publicly funded maternity services that offered the option of water birth between June 2011 and June 2013. Sixteen midwives were interviewed on a one to one basis. An additional 10 midwives participated in a focus group interview. FINDINGS: three main categories emerged from the data analysis: what came before the journey, becoming confident - the journey and staying confident. Each contained between three and five subcategories. Together they depicted how midwives describe the journey to becoming confident to support women who have chosen the option to water birth and how they are able to retain that confidence once achieved. IMPLICATIONS FOR PRACTICE: three key implications emerged from this study, the first was that students and graduate midwives could benefit from the opportunity to work in midwifery led maternity settings that support normal physiological child birth and that accessing such practical placements should be encouraged. Secondly, maternity services would benefit from learning opportunities directed specifically at experienced midwives addressing their particular requirements. Finally, midwives are the custodians of normal physiological birth, attendance at educational days with a focus on supporting this primary role should be mandatory, to inform midwives on current evidence found to support normal birth which includes options such as water birth.

Secondary anchor polymorphism in the HA-1 minor histocompatibility antigen critically affects MHC stability and TCR recognition.

T cell recognition of minor histocompatibility antigens (mHags) underlies allogeneic immune responses that mediate graft-versus-host disease and the graft-versus-leukemia effect following stem cell transplantation. Many mHags derive from single amino acid polymorphisms in MHC-restricted epitopes, but our understanding of the molecular mechanisms governing mHag immunogenicity and recognition is incomplete. Here we examined antigenic presentation and T-cell recognition of HA-1, a prototypic autosomal mHag derived from single nucleotide dimorphism (HA-1(H) versus HA-1(R)) in the HMHA1 gene. The HA-1(H) peptide is restricted by HLA-A2 and is immunogenic in HA-1(R/R) into HA-1(H) transplants, while HA-1(R) has been suggested to be a "null allele" in terms of T cell reactivity. We found that proteasomal cleavage and TAP transport of the 2 peptides is similar and that both variants can bind to MHC. However, the His>Arg change substantially decreases the stability and affinity of HLA-A2 association, consistent with the reduced immunogenicity of the HA-1(R) variant. To understand these findings, we determined the structure of an HLA-A2-HA-1(H) complex to 1.3A resolution. Whereas His-3 is accommodated comfortably in the D pocket, incorporation of the lengthy Arg-3 is predicted to require local conformational changes. Moreover, a soluble TCR generated from HA-1(H)-specific T-cells bound HA-1(H) peptide with moderate affinity but failed to bind HA-1(R), indicating complete discrimination of HA-1 variants at the level of TCR/MHC interaction. Our results define the molecular mechanisms governing immunogenicity of HA-1, and highlight how single amino acid polymorphisms in mHags can critically affect both MHC association and TCR recognition.

Neuropsychological near normality and brain structure abnormality in schizophrenia.

OBJECTIVE: Cognitive deficits are prominent in schizophrenia. Patients have an average score one standard deviation below normal on a broad spectrum of cognitive tests. It has been repeatedly noted, however, that 20%-25% of patients differ from this general pattern and score close to normal on neuropsychological testing. This study used brain morphometry to 1) identify brain abnormalities associated with more severe cognitive deficits and 2) help determine whether cognitively relatively intact patients perform better because they have less severe illness or because they have a different illness. METHOD: Patients were assigned to a neuropsychologically near normal (N=21) subgroup if they scored within 0.5 standard deviation of healthy comparison subjects (N=30) on four tests of attention and verbal and nonverbal working memory, and to a neuropsychologically impaired (N=54) group if they scored at least 1.0 standard deviation below that of comparison subjects. Subgroup assignments were confirmed with the California Verbal Learning Test and degraded-stimulus Continuous Performance Test. Volumes of ventricular compartments, hippocampus, amygdala, thalamus, cerebellum, and regional cortical gray and white matter were dependent variables. Differences among groups were evaluated by using linear mixed-model multivariate analyses with gender, age, and height as covariates. RESULTS: Both neuropsychologically near normal and neuropsychologically impaired patients had markedly smaller gray matter and larger third ventricle volumes than healthy comparison subjects. Only neuropsychologically impaired patients, however, had significantly smaller white matter and larger lateral ventricle volumes than healthy comparison subjects. CONCLUSIONS: Although both neuropsychologically impaired and neuropsychologically near normal patients have marked neuropathology in their gray matter, the relative absence of white matter pathology in the neuropsychologically near normal group suggests the possibility of differences in the disease process.

Effects of improved home heating on asthma in community dwelling children: randomised controlled trial.

OBJECTIVE: To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma. DESIGN: Randomised controlled trial. SETTING: Households in five communities in New Zealand. PARTICIPANTS: 409 children aged 6-12 years with doctor diagnosed asthma. INTERVENTIONS: Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial. MAIN OUTCOME MEASURES: The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV(1)). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child's general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child's bedroom were recorded hourly. RESULTS: Improvements in lung function were not significant (difference in mean FEV(1) 130.7 ml, 95% confidence interval -20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10 degrees C (95% confidence interval 0.54 degrees C to 1.64 degrees C) and in the child's bedroom of 0.57 degrees C (0.05 degrees C to 1.08 degrees C). Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households (geometric mean 8.5 microg/m(3) v 15.7 microg/m(3), P<0.001). A similar effect was found in the children's bedrooms (7.3 microg/m(3) v 10.9 microg/m(3), P<0.001). CONCLUSION: Installing non-polluting, more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, healthcare utilisation, and visits to a pharmacist. TRIAL REGISTRATION: Clinical Trials NCT00489762.

CXCL10-CXCR3 interactions play an important role in the pathogenesis of acute graft-versus-host disease in the skin following allogeneic stem-cell transplantation.

Acute graft-versus-host disease (aGVHD) remains a serious complication following allogeneic stem-cell transplantation (SCT), and is mediated by infiltration of alloreactive donor T cells into recipient tissue. Chemokines and their receptors play a central role in controlling the recruitment of T cells into discrete tissue sites, and determine the clinical features of GVHD in murine models. In this study, we have analyzed the serum concentration of molecules that control leukocyte migration in serial samples from 34 patients following allogeneic SCT. The chemokine CXCL10 (IP-10) was significantly elevated (> 2-fold) in serum at the time of aGVHD. Because the ligand for CXCL10 is CXCR3, the number of CXCR3(+) T cells was determined in peripheral blood, but was not increased during episodes of GVHD. To investigate the role of chemokines in the recruitment of T cells to the anatomic site of GVHD, skin biopsies were stained for CXCL10 and CXCR3 expression. CXCL10 expression was observed in the basal keratinocytes of the epidermis in patients with GVHD together with positive staining for CXCR3 on cells in dermal infiltrates. These findings indicate that CXCL10 plays a central role in the pathogenesis of skin aGVHD by the recruitment of CXCR3(+) T cells to the sites of inflammation.

A pilot study of a weight management program with food provision in schizophrenia.

Obesity is a serious medical problem that disproportionately affects people with severe mental illness. Behavioral strategies aimed at lifestyle modification have proven effective for weight loss in general population but have not been studied adequately among persons with schizophrenia. We have conducted a randomized controlled pilot trial of an established weight loss program, modified for this specific population, and supplemented with a novel food replacement program, as well as practical, community based teaching of shopping and preparing healthy food. The program not only arrested weight gain, and produced meaningful weight loss, but also weight loss continued 6 months after the intervention is completed. Cognitive impairment had no bearing to the extent a participant benefited from the program. As a conclusion, well designed simple behavioral programs can produce lasting weight loss for patients with schizophrenia and comorbid obesity, improve metabolic indices, and possibly decrease significant medical risks associated with obesity.

Marketing fat and sugar to children on New Zealand television.

BACKGROUND: We aimed to determine the frequency and content of television food advertisements during children's viewing times on various New Zealand television channels. METHODS: A content analysis was conducted of two free-to-air channels covering a total of 155 h of television time during children's viewing times (n = 858 food advertisements in 2005). Comparisons were made with data from 1997 and data from Australia. RESULTS: Compared to Australian channels, both New Zealand channels (TV3 and TV2) had significantly higher proportions of food advertisements that were classified as being "high in fat and/or sugar" (54% versus 80% and 69%, respectively). Using a more detailed classification system, 70.3% of food advertisements on the New Zealand channels were for foods "counter to improved nutrition" (95% CI: 67.1%, 73.3%) compared to those "favoring improved nutrition" at 5.1% (95% CI: 3.8%, 6.9%). The number of food advertisements per hour was higher in 2005 than in 1997 for the channel (TV2) for which there was time trend data (12.8 versus 8.0 per hour for the afternoon time slot). CONCLUSIONS: These findings provide further evidence that the majority of food advertising on New Zealand television is counter to nutritional guidelines. They suggest the need for further regulatory or other controls.

Cdc42 and Par6-PKCzeta regulate the spatially localized association of Dlg1 and APC to control cell polarization.

Cell polarization is essential in a wide range of biological processes such as morphogenesis, asymmetric division, and directed migration. In this study, we show that two tumor suppressor proteins, adenomatous polyposis coli (APC) and Dlg1-SAP97, are required for the polarization of migrating astrocytes. Activation of the Par6-PKCzeta complex by Cdc42 at the leading edge of migrating cells promotes both the localized association of APC with microtubule plus ends and the assembly of Dlg-containing puncta in the plasma membrane. Biochemical analysis and total internal reflection fluorescence microscopy reveal that the subsequent physical interaction between APC and Dlg1 is required for polarization of the microtubule cytoskeleton.

The activity of the plexin-A1 receptor is regulated by Rac.

Plexins constitute a large family of transmembrane proteins that act as receptors for the semaphorin family of ligands. They are best known for their role in growth cone guidance, although they also are widely expressed outside the nervous system. Plexins are thought to control axon guidance by modifying the growth cone cytoskeleton, and Rho GTPases have been strongly implicated in this response. However, the exact contribution of Rho proteins is unclear. Sema3A/Plexin-A1-induced growth cone collapse, for example, requires Rac activity, which is a surprising result given that this GTPase is usually associated with membrane protrusions. We show here that Sema3A-induced collapse of COS-7 cells expressing Plexin-A1 also requires Rac but not Rho activity and that the cytoplasmic tail of Plexin-A1 interacts directly with activated Rac. However, collapse induced by a constitutively activated version of Plexin-A1 does not require Rac. We propose a novel function for Rac, namely that it acts upstream of Plexin-A1 during semaphoring-induced collapse, to regulate the activity of the receptor.