Chemical immobilisation of lions: weighing up drug effectiveness versus clinical effects.

Selection of an effective drug combination to immobilise African lions (Panthera leo) requires balancing immobilisation effectiveness with potential side effects. We compared the immobilisation effectiveness and changes to physiological variables induced by three drug combinations used for free-ranging African lions. The lions (12 animals per drug combination) were immobilised with tiletamine-zolazepam-medetomidine (TZM), ketamine-medetomidine (KM) or ketamine-butorphanol-medetomidine (KBM). Induction, immobilisation, and recovery were timed, evaluated using a scoring system, and physiological variables were monitored. The drugs used for immobilisation were antagonised with atipamezole and naltrexone. The quality of induction was rated as excellent for all drug combinations and induction times (mean ± SD) did not differ between the groups (10.54 ± 2.67 min for TZM, 10.49 ± 2.63 min for KM, and 11.11 ± 2.91 min for KBM). Immobilisation depth was similar over the immobilisation period in the TZM and KBM groups, and initially light, progressing to deeper in lions administered KM. Heart rate, respiratory rate and peripheral arterial haemoglobin saturation with oxygen were within the expected range for healthy, awake lions in all groups. All lions were severely hypertensive and hyperthermic throughout the immobilisation. Following antagonism of immobilising drugs, lions immobilised with KM and KBM recovered to walking sooner than those immobilised with TZM, at 15.29 ± 10.68 min, 10.88 ± 4.29 min and 29.73 ± 14.46 min, respectively. Only one lion in the KBM group exhibited ataxia during recovery compared to five and four lions in the TZM and KM groups, respectively. All three drug combinations provided smooth inductions and effective immobilisations but resulted in hypertension. KBM had an advantage of allowing for shorter, less ataxic recoveries.

Quantification of cytosol and membrane proteins in rumen epithelium of sheep with low or high CH4 emission phenotype.

BACKGROUND: Ruminant livestock are a major contributor to Australian agricultural sector carbon emissions. Variation in methane (CH4) produced from enteric microbial fermentation of feed in the reticulo-rumen of sheep differs with different digestive functions. METHOD: We isolated rumen epithelium enzymatically to extract membrane and cytosol proteins from sheep with high (H) and low (L) CH4 emission. Protein abundance was quantified using SWATH-mass spectrometry. RESULTS: The research found differences related to the metabolism of glucose, lactate and processes of cell defence against microbes in sheep from each phenotype. Enzymes in the methylglyoxal pathway, a side path of glycolysis, resulting in D-lactate production, differed in abundance. In the H CH4 rumen epithelium the enzyme hydroxyacylglutathione hydrolase (HAGH) was 2.56 fold higher in abundance, whereas in the L CH4 epithelium lactate dehydrogenase D (LDHD) was 1.93 fold higher. Malic enzyme 1 which converts D-lactate to pyruvate via the tricarboxylic cycle was 1.57 fold higher in the L CH4 phenotype. Other proteins that are known to regulate cell defence against microbes had differential abundance in the epithelium of each phenotype. CONCLUSION: Differences in the abundance of enzymes involved in the metabolism of glucose were associated with H and L CH4 phenotype sheep. Potentially this represents an opportunity to use protein markers in the rumen epithelium to select low CH4 emitting sheep.

Analysis of rare disruptive germline mutations in 2135 enriched BRCA-negative breast cancers excludes additional high-impact susceptibility genes.

BACKGROUND: Breast cancer has a significant heritable basis, of which ∼60% remains unexplained. Testing for BRCA1/BRCA2 offers useful discrimination of breast cancer risk within families, and identification of additional breast cancer susceptibility genes could offer clinical utility. PATIENTS AND METHODS: We included 2135 invasive breast cancer cases recruited via the Breast and Ovarian Cancer Susceptibility study, a retrospective UK study of familial breast cancer. ELIGIBILITY CRITERIA: female, BRCA-negative, white European ethnicity, and one of: (i) breast cancer family history, (ii) bilateral disease, (iii) young age of onset (<30 years), and (iv) concomitant ovarian cancer. We undertook exome sequencing of cases and carried out gene-level burden testing of rare damaging variants against those from 51 377 ethnicity-matched population controls from gnomAD. RESULTS: 159/2135 (7.4%) cases had a qualifying variant in an established breast cancer susceptibility gene, with minimal evidence of signal in other cancer susceptibility genes. Known breast cancer susceptibility genes PALB2, CHEK2, and ATM were the only genes to retain statistical significance after correcting for multiple testing. Due to the enrichment of hereditary cases in the series, we had good power (>80%) to detect a gene of BRCA1-like risk [odds ratio (OR) = 10.6] down to a population minor allele frequency of 4.6 × 10-5 (1 in 10 799, less than one-tenth that of BRCA1)and of PALB2-like risk (OR = 5.0) down to a population minor allele frequency of 2.8 × 10-4 (1 in 1779, less than half that of PALB2). Power was lower for identification of novel moderate penetrance genes (OR = 2-3) like CHEK2 and ATM. CONCLUSIONS: This is the largest case-control whole-exome analysis of enriched breast cancer published to date. Whilst additional breast cancer susceptibility genes likely exist, those of high penetrance are likely to be of very low mutational frequency. Contention exists regarding the clinical utility of such genes.

Forensic professional's thoughts on New Zealand emergency nurse's forensic science knowledge and practice.

INTRODUCTION: The clinical forensic nursing role in emergency departments is a recognised nursing speciality globally but there is no designated clinical forensic role in New Zealand nor is their adequate tertiary education despite New Zealand emergency nurses being expected to be able to complete these duties if required. The study sought to find out the perceptions of forensic professionals about 1) how well if at all forensic protocols and practices are adhered to by emergency nurses in New Zealand, 2) what areas of forensic practice if any do ED nurses need tertiary training in to effectively care for patients with health conditions related to violence, and, 3) what relationship exists between emergency nurses and forensic professionals. METHODS: Health professionals in forensic nursing roles were invited to complete an anonymous, online survey consisting of Likert scale questions and free text commentary. A descriptive, content analysis of the data was undertaken. RESULTS: Content analysis described, incorrect evidence collection, erroneous chain of custody errors, limited relationship between emergency nurses and forensic professionals and clear support for a postgraduate clinical forensic nursing programme. DISCUSSION: This study identified that forensic science knowledge and practices by emergency nurses are inadequate for the work they are required to undertake, suggesting that additional professional development is warranted in order to maintain best practice standards for forensic emergency care.

School-based surveillance of acute infectious disease in children: a systematic review.

BACKGROUND: Syndromic surveillance systems are an essential component of public health surveillance and can provide timely detection of infectious disease cases and outbreaks. Whilst surveillance systems are generally embedded within healthcare, there is increasing interest in novel data sources for monitoring trends in illness, such as over-the-counter purchases, internet-based health searches and worker absenteeism. This systematic review considers the utility of school attendance registers in the surveillance of infectious disease outbreaks and occurrences amongst children. METHODS: We searched eight databases using key words related to school absence, infectious disease and syndromic surveillance. Studies were limited to those published after 1st January 1995. Studies based in nursery schools or higher education settings were excluded. Article screening was undertaken by two independent reviewers using agreed eligibility criteria. Data extraction was performed using a standardised data extraction form. Outcomes included estimates of absenteeism, correlation with existing surveillance systems and associated lead or lag times. RESULTS: Fifteen studies met the inclusion criteria, all of which were concerned with the surveillance of influenza. The specificity of absence data varied between all-cause absence, illness absence and syndrome-specific absence. Systems differed in terms of the frequency of data submissions from schools and the level of aggregation of the data. Baseline rates of illness absence varied between 2.3-3.7%, with peak absences ranging between 4.1-9.8%. Syndrome-specific absenteeism had the strongest correlation with other surveillance systems (r = 0.92), with illness absenteeism generating mixed results and all-cause absenteeism performing the least well. A similar pattern of results emerged in terms of lead and lag times, with influenza-like illness (ILI)-specific absence providing a 1-2 week lead time, compared to lag times reported for all-cause absence data and inconsistent results for illness absence data. CONCLUSION: Syndrome-specific school absences have potential utility in the syndromic surveillance of influenza, demonstrating good correlation with healthcare surveillance data and a lead time of 1-2 weeks ahead of existing surveillance measures. Further research should consider the utility of school attendance registers for conditions other than influenza, to broaden our understanding of the potential application of this data for infectious disease surveillance in children. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2019 CRD42019119737.

Risk factors associated with outbreaks of seasonal infectious disease in school settings, England, UK.

Children are important transmitters of infection. Within schools they encounter large numbers of contacts and infections can spread easily causing outbreaks. However, not all schools are affected equally. We conducted a retrospective analysis of school outbreaks to identify factors associated with the risk of gastroenteritis, influenza, rash or other outbreaks. Data on reported school outbreaks in England were obtained from Public Health England and linked with data from the Department for Education and the Office for Standards in Education, Children's Services and Skills (Ofsted). Primary and all-through schools were found to be at increased risk of outbreaks, compared with secondary schools (odds ratio (OR) 5.82, 95% confidence interval (CI) 4.50-7.58 and OR 4.66, 95% CI 3.27-6.61, respectively). School size was also significantly associated with the risk of outbreaks, with higher odds associated with larger schools. Attack rates were higher in gastroenteritis and influenza outbreaks, with lower attack rates associated with rashes (relative risk 0.17, 95% CI 0.15-0.20). Deprivation and Ofsted rating were not associated with either outbreak occurrence or the subsequent attack rate. This study identifies primary and all-through schools as key settings for health protection interventions. Public health teams need to work closely with these schools to encourage early identification and reporting of outbreaks.

Building health-promoting sports clubs: a participative concept mapping approach.

OBJECTIVES: The potential of sports clubs to promote health beyond physical activity has been acknowledged by researchers and policy-makers. This study gathered stakeholder ideas on support sports clubs need to increase health promotion efforts and prioritize them based on importance and feasibility. STUDY DESIGN: The study design used in this study is a mixed-methods concept mapping approach. METHODS: French sports and public health stakeholders (n = 45) were invited to participate. Steps included are as follows: (1) formulating a focus prompt, (2) brainstorming statements in response to the focus prompt, (3) sorting statements into themed piles, and (4) rating statements based on indicators. Multidimensional scaling and hierarchical cluster analysis were used to produce visual cluster maps, and descriptive statistics generated Go-Zone graphs based on mean importance and feasible ratings. RESULTS: Participants generated 62 statements from the focus prompt: 'What assistance would benefit sports clubs to become a health-promoting setting?'. Final sorting produced 9 clusters: Tools for health promotion, Communication tools, Stakeholder training courses, Diagnostic and Financing, Awareness and Mobilization, Advocacy, Policies and Methods, Sharing and Networking, as well as Communication and Dissemination. Participant ratings produced 34 statements within the Go-Zone graphs. CONCLUSION: Understanding stakeholders' needs to increase health promotion activities in sports clubs is crucial to planning and implementing sustainable health promotion policies and practice. Priority areas include increasing awareness of health promotion benefits, mobilizing actors, advocating for support, and educating sports club actors.

Attitudes of sports organisation members to junk food sponsorship.

OBJECTIVES: To explore sports organisation members' attitudes to sponsorship of sport by energy-dense, nutrient-poor food and drink ('junk food') brands. STUDY DESIGN: The study design is a cross-sectional study. METHODS: An online survey of adult members of three sports organisations that did not accept junk food sponsorship in Victoria, Australia in 2018: one was responsible for an elite team in a national competition (5000-10,000 members); one managed a team sport competition across Victoria (50,000-100,000 registered junior and adult participants, referees and coaches); and one administered a junior team sport competition for boys and girls in a major city (10,000-15,000 participants). RESULTS: Most (71%) of the 2224 respondents reported it was important/very important that their organisation did not accept junk food sponsorship. A higher proportion was concerned/very concerned about junk food companies sponsoring children's sport (60%) compared with such companies sponsoring elite (49%, P < 0.001) or community adult (39%, P < 0.001) sport. A higher proportion of respondents were likely/very likely to support a policy that restricted junk food sponsorship of children's sport (84%), compared with a policy restricting sponsorship of elite (76%, P > 0.001) and adult community (74%, P > 0.001) sport. Two-thirds of respondents supported restricting junk food companies from sponsoring sport, even if fees for children's (66%) and community adult (65%) sport increased, or if membership and attendance costs for elite sport supporters increased (63%). CONCLUSIONS: In the Australian context of this study, junk food sponsorship of sport, particularly children's sport, is a concern to members of sports organisations. Although still high, support for restricting such sponsorship declines if members perceive it will lead to increases in participation costs and decreases in participation opportunities. Initiatives restricting junk food sponsorship of sport are likely to receive strong support from the sports community, particularly when the focus is on children's sport, and participation costs and opportunities are not negatively impacted.

New Zealand emergency nurses knowledge about forensic science and its application to practice.

INTRODUCTION: Violence is a major public health problem worldwide. Emergency nurses are often in a unique position to identify, assess, evaluate, and treat these patients, but there is limited forensic knowledge and skills to enable emergency nurses to feel confident to guide their practice in New Zealand. The purpose of this study was to establish the level of forensic knowledge and skills currently known and used by nurses in clinical practice working in New Zealand District Health Boards (DHB)'s emergency departments. The study aimed to develop a tertiary education course based on the needs and the knowledge required, to enable nurses to practice confidently and safely with Forensic patients in the emergency department setting. METHODS: A descriptive approach using online questionnaires including both quantitative and qualitative components was sent to all emergency departments in New Zealand DHB's as well as the New Zealand Nurses Organisation (NZNO) emergency nurses' section. Open-ended questions were analysed by thematic analysis. Closed questions were analysed by SPSS version 15 data analysis software (SPSS Inc, Chicago, IL). Themes identified focused on the knowledge and skills emergency nurses currently possess and the level of specialist education required to ensure patients receive the best medicolegal care. RESULTS: Results of the questionnaire revealed limited knowledge in being able to correctly identify all forensic patients, insufficient knowledge around evidence preservation and collection and limited knowledge around legislation or legal processes governing clinical care were discovered. However, 84% of all participants felt that having forensic knowledge was important for their practice, indicating a need for increased forensic education. Practice implications indicate that forensic education is warranted, needed and desired among ED nurses within the clinical setting. DISCUSSION: As forensic patients generally require emergency medical attention, it is important that nurses as part of the front-line first responders have forensic knowledge around preservation and collection of evidence during the provision of medical care. It was found that, emergency nurses do not have enough knowledge around forensic issues indicating that forensic education is warranted, needed and desired among ED nurses within the clinical setting. The study also provides support for the implementation of tertiary forensic science nursing postgraduate study in New Zealand.

Validation of an Oral Disease Severity Score (ODSS) tool for use in oral mucous membrane pemphigoid.

BACKGROUND: Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease predominantly affecting the oral mucosa. Optimal management relies upon thorough clinical assessment and documentation at each visit. OBJECTIVES: The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in MMP. We also compared its inter- and intraobserver reliability with those of the oral parts of the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Physician's Global Assessment (PGA). METHODS: Fifteen patients with mild-to-moderately severe oral MMP were scored for disease severity by 10 oral medicine clinicians from four U.K. centres using the ODSS, the oral sections of MMPDAI and ABSIS, and PGA. Two clinicians rescored all patients after 2 h. RESULTS: In terms of reliability, the interobserver ODSS total score intraclass correlation coefficient (ICC) was 0·97, MMPDAI activity 0·59 and damage 0·15, ABSIS total 0·84, and PGA 0·72. The intraobserver ICCs (two observers) for ODSS total were 0·97 and 0·93; for MMPDAI activity 0·93 and 0·70 and damage 0·93 and 0·79; for ABSIS total 0·99 and 0·94; and for PGA 0·92 and 0·94. Convergent validity between ODSS and MMPDAI was good (correlation coefficient 0·88). The mean ± SD time for completion of ODSS was 93 ± 31 s, with MMPDAI 102 ± 24 s and ABSIS involvement 71 ± 18 s. The PGA took < 5 s. CONCLUSIONS: This study has validated the ODSS for the assessment of oral MMP. It has shown superior interobserver agreement over MMPDAI, ABSIS and PGA, and superior intraobserver reliability to MMPDAI. It is quick and easy to perform. What's already known about this topic? There are no validated scoring methodologies for oral mucous membrane pemphigoid (MMP). Proposed disease activity scoring tools for MMP include the Mucous Membrane Disease Area Index (MMPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). The Oral Disease Severity Score (ODSS) has been validated for use in oral pemphigus vulgaris (PV). It has been shown to be reliable and sensitive in both lichen planus (LP) and MMP. What does this study add? The ODSS has been shown to be a thorough, sensitive and reproducible, yet quick scoring tool for the assessment of oral involvement in MMP. Its versatility for use in oral PV, MMP and LP is an added advantage over other scoring methodologies. What are the clinical implications of this work? We propose that the ODSS be used as a clinical scoring tool for monitoring activity in oral MMP in clinical practice as well as for use in multicentre studies.

Infrared thermography and ulcer prevention in the high-risk diabetic foot: data from a single-blind multicentre controlled clinical trial.

AIM: To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence. METHODS: People with diabetes (n = 110), neuropathy and history of ≥ 1 foot ulcer participated in a single-blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature ≥ 2.2°C higher than the corresponding contralateral site) and acted upon as per local standards. RESULTS: After 12 months, 62% of participants were ulcer-free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively. CONCLUSIONS: Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer-free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow-up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.

Co-creation of a sport-specific anterior cruciate ligament injury risk reduction program for women: A concept mapping approach.

OBJECTIVES: To engage physiotherapists experienced in female elite sport and athletes to co-create a sport-specific anterior cruciate ligament (ACL) injury risk reduction program. DESIGN: Concept Mapping. METHODS: The Concept Systems Global MAX™ web platform was used to collect and analyse data from 27 context and content experts (22 physiotherapists, 5 athletes). Participants brainstormed statements representing the critical elements that should be included in an ACL injury risk reduction program for women playing elite Australian Football (AF). RESULTS: Twenty-two participants brainstormed 56 statements that were synthesised and edited to 62 statements. Statements were sorted into clusters by twenty-three participants and rated on importance and feasibility using six-point scales. Multidimensional scaling and cluster analysis identified a 5-cluster solution as follows: Football-specific preparation (15 statements); Movement skills (17 statements); Strength and conditioning (15 statements); Individual preparation (7 statements); and Education (8 statements). Calculation of mean ratings for each cluster and statement identified the Movement skills cluster as most important (mean=3.61 out of 5) and the Football-specific preparation cluster as most feasible (3.75 out of 5). By contrast, the Individual preparation cluster was rated the least important (mean=2.9 out of 5), and the least feasible (3.12 out of 5), to include in the program. CONCLUSIONS: The five clusters of critical elements to include in an ACL injury risk reduction program for women playing elite AF, in order of most to least importance were: movement skills, football-specific preparation, education, strength and conditioning and individual preparation.

Symptom profiling for infectious intestinal disease (IID): a secondary data analysis of the IID2 study.

Less than half of stool samples from people symptomatic with infectious intestinal disease (IID) will identify a causative organism. A secondary data analysis was undertaken to explore whether symptomology alone could be used to make inferences about causative organisms. Data were utilised from the Second Study of Infectious Intestinal Disease in the Community. A total of 844 cases were analysed. Few symptoms differentiated individual pathogens, but grouping pathogens together showed that viral IID was more likely when symptom onset was in winter (odds ratio (OR) 2.08, 95% confidence interval (CI) 1.16-3.75) or spring (OR 1.92, 95% CI 1.11-3.33), the patient was aged under 5 years (OR 3.63, 95% CI 2.24-6.03) and there was loss of appetite (OR 2.19, 95% CI 1.29-3.72). The odds of bacterial IID were higher with diarrhoea in the absence of vomiting (OR 3.54, 95% CI 2.37-5.32), diarrhoea which persisted for >3 days (OR 2.69, 95% CI 1.82-3.99), bloody diarrhoea (OR 4.17, 95% CI 1.63-11.83) and fever (OR 1.67, 95% CI 1.11-2.53). Symptom profiles could be of value to help guide clinicians and public health professionals in the management of IID, in the absence of microbiological confirmation.

Protein profiles of enzymatically isolated rumen epithelium in sheep fed a fibrous diet.

BACKGROUND: The rumen wall plays a major role in efficient transfer of digested nutrients in the rumen to peripheral tissues through the portal venous system. Some of these substrates are metabolised in the epithelium during this process. To identify the specific proteins involved in these processes, we used proteomic technologies. Protein extracts were prepared from ventral rumen tissue of six sheep fed a fibrous diet at 1.5× maintenance energy requirements. Using a newly developed method, we were able to enzymatically isolate the epithelial cells from underlying tissue layers, thus allowing cytosol and membrane fractions to be independently analysed using liquid chromatography tandem mass spectrometry (LC MS/MS). RESULTS: Using our procedure we identified 570 epithelial proteins in the Ovis aries sequence database. Subcellular locations were largely cytosolic (n = 221) and extracellular (n = 85). However, a quarter of the proteins identified were assigned to the plasma membrane or organelle membranes, some of which transport nutrients and metabolites. Of these 91 were transmembrane proteins (TMHMM), 27 had an N-terminal signal peptide (signalP) and TMHMM motif, 13 had a glycosylphosphatidylinositol (GPI) anchor and signalP sequence, 67 had beta (ß) strands or 17 ß strands and a transit peptide sequence, indicating the identified proteins were integral or peripheral membrane proteins. Subunits of the 5 protein complexes involved in mitochondrial cellular energy production were well represented. Structural proteins (15%), proteins involved in the metabolism of lipids and proteins (26%) and those with steroid or cytokine action were a feature of the proteome. CONCLUSION: Our research has developed a procedure to isolate rumen epithelium proteins from the underlying tissue layers so that they may be profiled using proteomic technologies. The approach improves the number of proteins that can be profiled that are specific to the epithelium of the rumen wall. It provides new insights into the proteins of structural and nutritional importance in the rumen epithelium, that carry out nutrient transport and metabolism, cell growth and signalling.

Barriers to rejecting junk food sponsorship in sport-a formative evaluation using concept mapping.

OBJECTIVES: Energy-dense, nutrient-poor food and drink ('junk food') brands sponsoring sport is a growing public health concern. This study explored sports administrators' perceptions of the barriers to rejecting junk food sponsorship. STUDY DESIGN: This study used concept mapping. METHODS: The Concept Systems Global MAX™ web platform was used to collect and analyse data from 29 sports administrators across all levels of sport in Victoria, Australia. RESULTS: Brainstorming generated 33 barriers to rejecting junk food sponsorship. After the barriers were synthesised and edited, participants sorted and rated 32 barriers. Multidimensional scaling and hierarchical cluster analysis identified a four-cluster solution: community attitudes and values (seven barriers); junk food is the easy sell (retail; five barriers); financial viability (16 barriers); and organisational capability (policy and governance; four barriers). The financial viability barriers were rated the most important (mean = 3.65 of 5) and the hardest to overcome (1.42). The organisational capability (policy and governance) barriers were rated the least important (2.14) and the easiest to overcome (3.20). CONCLUSIONS: Sports administrators clearly perceive that rejecting junk food sponsorship could place significant financial strain on their organisations. There appears to be considerable scope to build the capacity of sporting organisations to rejecting junk food sponsorship. Despite the literature indicating that most parents think junk food companies are not suitable sponsors, sports administrators perceive that there is a broad public acceptance of junk food sponsorship in sport. The fact that sports administrators perceive a link between junk food sponsorship and the lack of healthy options at club canteens and venue food outlets adds an additional, not previously identified, level of complexity to the junk food sponsorship in sport debate.

Reliability of a novel thermal imaging system for temperature assessment of healthy feet.

BACKGROUND: Thermal imaging is a useful modality for identifying preulcerative lesions ("hot spots") in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet. METHODS: Plantar skin foot temperatures were measured with the novel thermal imaging device (Diabetic Foot Ulcer Prevention System (DFUPS), constructed by Photometrix Imaging Ltd) and also with a hand-held infrared spot thermometer (Thermofocus® 01500A3, Tecnimed, Italy) after 20 min of barefoot resting with legs supported and extended in 105 subjects (52 males and 53 females; age range 18 to 69 years) as part of a multicentre clinical trial. The temperature differences between the right and left foot at five regions of interest (ROIs), including 1st and 4th toes, 1st, 3rd and 5th metatarsal heads were calculated. The intra-instrument agreement (three repeated measures) and the inter-instrument agreement (hand-held thermometer and thermal imaging device) were quantified using intra-class correlation coefficients (ICCs) and the 95% confidence intervals (CI). RESULTS: Both devices showed almost perfect agreement in replication by instrument. The intra-instrument ICCs for the thermal imaging device at all five ROIs ranged from 0.95 to 0.97 and the intra-instrument ICCs for the hand-held-thermometer ranged from 0.94 to 0.97. There was substantial to perfect inter-instrument agreement between the hand-held thermometer and the thermal imaging device and the ICCs at all five ROIs ranged between 0.94 and 0.97. CONCLUSIONS: This study reports the performance of a novel thermal imaging device in the assessment of foot temperatures in healthy volunteers in comparison with a hand-held infrared thermometer. The newly developed thermal imaging device showed very good agreement in repeated temperature assessments at defined ROIs as well as substantial to perfect agreement in temperature assessment with the hand-held infrared thermometer. In addition to the reported non-inferior performance in temperature assessment, the thermal imaging device holds the potential to provide an instantaneous thermal image of all sites of the feet (plantar, dorsal, lateral and medial views). TRIAL REGISTRATION: Diabetic Foot Ulcer Prevention System NCT02317835, registered December 10, 2014.

Phenotype of CNTNAP1: a study of patients demonstrating a specific severe congenital hypomyelinating neuropathy with survival beyond infancy.

CHN is genetically heterogeneous and its genetic basis is difficult to determine on features alone. CNTNAP1 encodes CASPR, integral in the paranodal junction high molecular mass complex. Nineteen individuals with biallelic variants have been described in association with severe congenital hypomyelinating neuropathy, respiratory compromise, profound intellectual disability and death within the first year. We report 7 additional patients ascertained through exome sequencing. We identified 9 novel CNTNAP1 variants in 6 families: three missense variants, four nonsense variants, one frameshift variant and one splice site variant. Significant polyhydramnios occurred in 6/7 pregnancies. Severe respiratory compromise was seen in 6/7 (tracheostomy in 5). A complex neurological phenotype was seen in all patients who had marked brain hypomyelination/demyelination and profound developmental delay. Additional neurological findings included cranial nerve compromise: orobulbar dysfunction in 5/7, facial nerve weakness in 4/7 and vocal cord paresis in 5/7. Dystonia occurred in 2/7 patients and limb contractures in 5/7. All had severe gastroesophageal reflux, and a gastrostomy was required in 5/7. In contrast to most previous reports, only one patient died in the first year of life. Protein modelling was performed for all detected CNTNAP1 variants. We propose a genotype-phenotype correlation, whereby hypomorphic missense variants partially ameliorate the phenotype, prolonging survival. This study suggests that biallelic variants in CNTNAP1 cause a distinct recognisable syndrome, which is not caused by other genes associated with CHN. Neonates presenting with this phenotype will benefit from early genetic definition to inform clinical management and enable essential genetic counselling for their families.

An Oral Disease Severity Score validated for use in oral pemphigus vulgaris.

BACKGROUND: Pemphigus vulgaris (PV) is a rare autoimmune bullous disease, which can present with recalcitrant oral mucosal lesions. Optimal management of PV relies upon careful clinical assessment and documentation. OBJECTIVES: The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in PV. A secondary aim was to compare its inter- and intraobserver variability and ease of use with the Physician's Global Assessment (PGA) and the oral scoring methods used in the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI). METHODS: Fifteen patients with mild-to-moderately severe oral PV were scored for disease severity by 10 oral medicine clinicians using the ODSS, the PGA and the oral sections of ABSIS and PDAI. Two clinicians rescored all patients after a minimum 2-h interval. RESULTS: Interobserver reliability was assessed using an intraclass correlation coefficient (ICC). For the ODSS total score the ICC was 0·83, for PDAI (oral total activity) 0·79, ABSIS (oral total) 0·71 and PGA 0·7. Intraobserver agreement between initial scoring and rescoring of the same patient by two clinicians demonstrated an ICC for each of 0·97 and 0·96 for ODSS total score; 0·99 and 0·82 for PDAI oral activity; 0·86 and 0·45 for ABSIS total; and 0·99 and 0·64 for PGA. Convergent validity was good, with a correlation coefficient > 0·5 (P < 0·001). The mean ± SD times taken to complete each scoring method were ODSS 76 ± 37 s, PDAI 117 ± 16 s and ABSIS 75 ± 19 s. CONCLUSIONS: This study has validated the ODSS for the assessment of oral PV. It has shown superior inter- and intraobserver reliability to PDAI, ABSIS and PGA and is quick to perform.