Search

Background Implementation of the cardiovascular disease (CVD) prevention guidelines in the UK has been repeatedly evaluated under the auspices of the British Cardiovascular Society in three Action on Secondary and Primary Prevention by Intervention to Reduce Events (ASPIRE) surveys in 1994–1995, 2008–2010 and 2017–2019. The primary care arm of ASPIRE-2-PREVENT (A-3-P) was conducted to evaluate lifestyle and medical risk factor management in people at high risk of atherosclerotic CVD in everyday clinical practice.Methods A-3-P was a cross-sectional survey in 27 general practices and health centres across 5 English National Health Service regions. Patients with no history of atherosclerotic CVD started on blood pressure and/or lipid and/or glucose lowering treatments were identified retrospectively and interviewed at least 6 months after the initiation of medication.Results 557 patients attended the interview and examination (45.8% women; mean age 61.7±10.8 years). The risk factor control was poor: 9.3% of patients were smokers, 38.1% obese (body mass index≥30 kg/m2) and 53.5% centrally obese (waist circumference≥88 cm for women, ≥102 cm for men). Only 37.8% of patients on blood pressure-lowering therapies achieved the target of

Professional development of scientists is enhanced by training students in responsible conduct of research earlier in their careers. One aspect of responsible conduct of research is authorship ethics, which concerns granting of credit to those who make intellectual contributions to the research. The activity discussed in this article emphasizes how authorship ethics can be integrated with Course-based Undergraduate Research Experience (CURE) and includes an adaption that could also be used for independent research students. The activity allows students to reflect upon inequalities and problems seen in scientific authorship, including gender bias, failure to credit effort (ghostwriters), and inclusion of authors that did not meaningfully contribute to the work (honorary/gift authorship). Themes seen in student reflections on how they could demonstrate ethics in authorship included: determining authorship by contribution, appropriate attributions on curriculum vitas (CV) and posters, different credit levels, understanding authorship criteria, and tracking contributions. Themes seen in student reflections on the importance of authorship were proper authorship credit distribution, authorship impacting career opportunities, and accountability in research. In the activity, students also created attributions for a poster to be presented from their research. We found that most students were able to create attributions that were correctly formatted, included the same authors, and positioned authors in the same order as other group members, matching what was presented on the finalized poster. We found that students' reflection on authorship and this professionalization of their activities in their CURE led to modest increases in their view of themselves as scientists.

This study reports on a five-year data set about the deaths of 599 individuals in New South Wales Australia, who at the time of their death were living in out-of-home care. Analysis aimed to: i) gain a clearer understanding of place of death for people with intellectual disability; and ii) identify and analyse associated variables to investigate how well they predict place of death for this population. Hospital admissions, polypharmacy and living situation were the strongest standalone predictors of place of death. A hospital death was more likely if the target population were subject to polypharmacy, lived in a group home, had a moderate intellectual disability or had GORD. Death, and place of death, is an issue requiring individual consideration. This study has identified some of the variables that need attention when supporting people with intellectual disability to have a good death.

Objectives Informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.Design In the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.Setting UK stroke services.Participants 3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.Results Of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.Conclusion It is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration number ISRCTN83290762; Post-results.

Background: The attitudes, perceptions and inherent biases of healthcare professionals (HCPs) have the potential to influence and inform health outcomes of people with intellectual disability. This review aimed to identify what educational interventions have been conducted to improve the attitude, knowledge, and confidence of HCPs in caring for people with intellectual disability. Method: A systematic literature review was conducted using Medline, ERIC and PsycINFO. Inclusion criteria included: articles published after 1980 in English, quantitative and mixed methods studies. Results: Of 1444 articles yielded, 10 met the inclusion criteria. Studies predominantly included doctors and nurses. Almost half (40%) of the studies reported interventions that were effective in changing perceived confidence and attitudes, while 60% achieved improvement in knowledge or skills based on Kirkpatrick classification. Conclusions: Training is valuable in improving knowledge, broadening perspectives, and increasing confidence in managing people with intellectual disability but there are limited studies in this area.

Students often see college courses as the presentation of disconnected facts, especially in the life sciences. Student-created Structure Mechanism/Relationship Function (SMRF) models were analyzed to understand students' abilities to make connections between genotype, phenotype, and evolution. Students were divided into two sections; one section received instructions that included a specific gene as an example related to larger issues like human disease or the environment. The other section was only given generic examples, like gene X and phenotype Y. Coding of exam models and a comprehensive (extensive) model reveled students were able to make links and work within and between biological scales of organization. Modeling provided a way to show and allow students to practice and demonstrate the ability to build step-by-step causal relationships that link ideas together. We also observed a small differing with students receiving the specific prompt performing better than students receiving generic prompt at the point in the semester where linking across many biological scales was required to be successful.

Universal design for learning (UDL) has been advocated for by adapted physical education scholars as a panacea to the challenges associated with teaching disabled and nondisabled students together in physical education. So much so that UDL currently occupies a privileged and largely unquestioned position in adapted physical education scholarship and practice, until now. To move scholarship forward, this article draws on published theoretical and empirical work relating to UDL generally and in physical education in particular to critically discuss the scientific research supporting, or not, the use of UDL as a so-called inclusive approach. We end this article with a call to action for scholars in this field, ourselves included, to conduct theoretically guided and empirically informed research relating to UDL in physical education, which adheres to established hallmarks of research quality that are tied to the ontological and epistemological assumptions of researchers because, at present, it is conspicuous by its absence.

Purpose: The purpose was to examine secondary physical education teachers' strength and conditioning (SC) knowledge and evaluate associations between SC teaching role, professional preparation, and development. Method: A knowledge survey was developed/validated and distributed to 2,189 middle/high school teachers, with 605 providing complete data. Results: Seventy-five percent of participants reported serving an SC-related teaching role, and mean SC knowledge was 6.77 correct out of 15 (45%). Participants with SC certification, who taught an SC unit/course, who supervised an SC sport program, and who taught in high school performed significantly better. Physical education teacher education preparation, including exercise physiology and weightlifting activity courses, was a significant predictor of SC knowledge. Professional development, such as SC online coursework, meeting with SC professionals, and reading SC publications, was also a significant predictor. Conclusion: To support physical education teachers' SC knowledge, physical education teacher education programs should include SC-related course offerings, and school administrators should consider offering professional development to physical education teachers who serve in SC roles.

Purpose: To examine socialization experiences of physical educators who deliver strength and conditioning (S&C) programming, particularly the development of subjective theories, expertise, orientations, and perceived mattering. Methods: Thirty-one secondary school physical educators providing S&C instruction/supervision as part of required duties completed in-depth interviews with Occupational Socialization Theory as a guiding framework for analysis. Results: Themes developed were: (a) acculturation and organizational socialization influence beliefs, (b) S&C professional development is scarce, (c) S&C in physical education is a sporting endeavor, (d) blurred lines between teaching and coaching, and (e) S&C-related programs matter. Discussion: Physical educators delivering S&C programming lack adequate preservice preparation and professional development, and experience both role conflict and decreased marginalization. Physical education teacher education programs should offer more formal S&C training for safe and effective instruction/supervision. Schools should provide S&C-related professional development to maximize student learning and safety and avoid potential legal liability.

The Education Sector of the recently updated National Physical Activity Plan (NPAP, 2023) was developed to assist schools, early care and education centers, and colleges and universities to establish policies and provide programmatic opportunities to support all students in adopting physically active lifestyles. The 2023 Education Sector strategies target K-12 education, preschool and early childhood education, as well as college and university contexts to develop and advocate for strong policies that promote physical education and physical activity for all students. Successful implementation of the Education Sector strategies has the potential to support high-quality program delivery. Specific to school physical education programs, the strategies' adoption has the capacity for a broad, lifelong impact. This article presents an overview of the Education Sector strategies and their related tactics, along with objectives specific for K-12 school physical education programming.

Past reductions of anthropogenic aerosol concentrations in Europe and North America could have amplified Arctic warming. In the future the impact of air pollution policies may differ, because the major anthropogenic sources of atmospheric aerosols are increasingly located in Asia. In this study numerical experiments evaluating only direct aerosol effects on atmospheric temperatures indicate that, while reduced carbon dioxide (CO _2 ) emissions weaken Arctic warming, direct radiative forcing effects by reductions of anthropogenic aerosol concentrations, additional to those obtained by lower CO _2 emissions, can either amplify or diminish it. Interactions between regionally modified radiation in Asia and internal climate variability may differently initiate and sustain atmospheric planetary waves propagating into the Arctic. In a nonlinear manner planetary waves may redistribute atmospheric and oceanic meridional heat fluxes at the high latitudes and either amplify or diminish Arctic warming in 2050. Lower CO _2 concentrations might apparently contribute to reduce the interactions between the Arctic system and the lower latitudes, thus reducing the influence of strong air quality measures in Asia on the Arctic amplification of global warming. While past and present air pollution policies could have amplified Arctic warming, in the future the effects from atmospheric pollution reductions are less certain, depending on the future CO _2 concentrations, and requiring improved simulations of changing aerosol concentrations and their interactions with clouds in Asia and the Arctic.

Marine heatwaves are increasingly affecting marine ecosystems, with cascading impacts on coastal economies, communities, and food systems. Studies of heatwaves provide crucial insights into potential ecosystem shifts under future climate change and put fisheries social-ecological systems through “stress tests” that expose both vulnerabilities and resilience. The 2014–16 Northeast Pacific heatwave was the strongest and longest marine heatwave on record and resulted in profound ecological changes that impacted fisheries, fisheries management, and human livelihoods. Here, we synthesize the impacts of the 2014–2016 marine heatwave on US and Canada West Coast fisheries and extract key lessons for preparing global fisheries science, management, and industries for the future. We set the stage with a brief review of the impacts of the heatwave on marine ecosystems and the first systematic analysis of the economic impacts of these changes on commercial and recreational fisheries. We then examine ten key case studies that provide instructive examples of the complex and surprising challenges that heatwaves pose to fisheries social-ecological systems. These reveal important insights into improving the resilience of monitoring and management and increasing adaptive capacity to future stressors. Key recommendations include: (1) expanding monitoring to enhance mechanistic understanding, provide early warning signals, and improve predictions of impacts; (2) increasing the flexibility, adaptiveness, and inclusiveness of management where possible; (3) using simulation testing to help guide management decisions; and (4) enhancing the adaptive capacity of fishing communities by promoting engagement, flexibility, experimentation, and failsafes. These advancements are important as global fisheries prepare for a changing ocean.

Teacher preparation programs need quality training courses that offer flexible, interactive alternatives to isolating online courses and classroom-based programs that limit students to a specific place and time. The HyFlex course design provides a solution by combining internet video instruction (such as Zoom), regular online learning, and face-to-face classroom experiences into one course where students can choose the method that best meets their individual learning needs and even alternate between methods throughout the course session. HyFlex aligns with learner centered instruction and offers a unique opportunity for educators to receive quality licensure courses. This article explores existing literature on the HyFlex course delivery method and discusses a case study done to examine student outcomes resulting from its use in a post-baccalaureate special education teacher licensure program.

Endocrine disrupting chemicals (EDCs) cause physiological abnormalities and population decline in fishes. However, few studies have linked environmental EDC exposures with responses at multiple tiers of the biological hierarchy, including population-level effects. To this end, we undertook a four-tiered investigation in the impacted San Francisco Bay estuary with the Mississippi silverside (Menidia audens), a small pelagic fish. This approach demonstrated links between different EDC sources and fish responses at different levels of biological organization. First we determined that water from a study site primarily impacted by ranch run-off had only estrogenic activity in vitro, while water sampled from a site receiving a combination of urban, limited ranch run-off, and treated wastewater effluent had both estrogenic and androgenic activity. Secondly, at the molecular level we found that fish had higher mRNA levels for estrogen-responsive genes at the site where only estrogenic activity was detected but relatively lower expression levels where both estrogenic and androgenic EDCs were detected. Thirdly, at the organism level, males at the site exposed to both estrogens and androgens had significantly lower mean gonadal somatic indices, significantly higher incidence of severe testicular necrosis and altered somatic growth relative to the site where only estrogens were detected. Finally, at the population level, the sex ratio was significantly skewed towards males at the site with measured androgenic and estrogenic activity. Our results suggest that mixtures of androgenic and estrogenic EDCs have antagonistic and potentially additive effects depending on the biological scale being assessed, and that mixtures containing androgens and estrogens may produce unexpected effects. In summary, evaluating EDC response at multiple tiers is necessary to determine the source of disruption (lowest scale, i.e. cell line) and what the ecological impact will be (largest scale, i.e. sex ratio).

Background: Surgical site infections (SSIs) are complications of surgery that cause significant postoperative morbidity. SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets. Objectives: We aimed to address a number of objectives. Firstly, identify risk factors for SSI, criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance (PDS). Secondly, test the importance of risk factors for SSI in surveillance databases and investigate interactions between risk factors. Thirdly, investigate and validate different definitions of SSI. Lastly, develop models for making risk-adjusted comparisons between hospitals. Data sources: A single hospital surveillance database was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service database to address objective 4. Study design: There were four elements to the research: (1) systematic reviews of risk factors for SSI (two reviewers assessed titles and abstracts of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale); (2) assessment of agreement between four SSI definitions; (3) validation of definitions of SSI, quantifying their ability to predict clinical outcomes; and (4) development of operation-specific risk models for SSI, with hospitals fitted as random effects. Results: Reviews of SSI risk factors other than established SSI risk indices identified other risk; some were operation specific, but others applied to multiple operations. The factor most commonly identified was duration of preoperative hospital stay. The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution. There was wide variation in SSI rate (SSI%) using different definitions. Over twice as many wounds were classified as infected by one definition only as were classified as infected by both. Different SSI definitions also classified different wounds as being infected. The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes. This finding is paradoxical given the poor agreement between definitions. Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both. Risk factors fitted in multivariable models and their effects, including age and gender, varied by surgical procedure. Operative duration was an important risk factor for all operations, except for hip replacement. Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers. The American Association of Anesthesiologists class was a consistent risk factor for most operations. Conclusions: The research literature does not allow surgery-specific or generic risk factors to be defined. SSI definitions varied between surveillance programmes and potentially between hospitals. Different definitions do not have good agreement, but the definitions have similar ability to predict outcomes influenced by SSI. Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures. There was no evidence for effect modification by hospital. Estimates of SSI% should be disseminated within institutions to inform infection control. Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care. Future research should focus on developing an SSI definition that has satisfactory psychometric properties, that can be applied in everyday clinical settings, includes PDS and is formulated to detect SSIs that are important to patients or health services. Funding: The National Institute for Health Research Technology Assessment programme.

Background: Sugammadex (Bridion®) is a newly developed agent for the reversal of neuromuscular blockade (NMB) induced by rocuronium or vecuronium. Sugammadex can reverse profound blockade and can be given for immediate reversal and its use would avoid the potentially serious adverse effects of the currently used agent, succinylcholine. Also, sugammadex can reverse NMB more quickly and predictably than existing agents. Objectives: To determine the clinical effectiveness and cost-effectiveness of sugammadex for the reversal of muscle relaxation after general anaesthesia in UK practice following routine or rapid induction of NMB. Data sources: Medical databases [including MEDLINE, EMBASE, CINAHL, Science Citation Index, BIOSIS and Cochrane Central Register of Controlled Trials (CENTRAL), conference proceedings, internet sites and clinical trials registers] were searched to identify published and unpublished studies. The main searches were carried out in May 2008 and supplemented by current awareness updates up until November 2008. Review methods: For the clinical effectiveness review, randomised controlled trials of sugammadex against placebo or an active comparator (neostigmine + glycopyrrolate) for the reversal of moderate or profound NMB and for immediate reversal (spontaneous recovery from succinylcholine-induced blockade) were included. The primary effectiveness outcome was speed of recovery from NMB, as measured by objective monitoring of neuromuscular function. For the cost-effectiveness review, a de novo economic assessment considered the routine induction of NMB and the rapid induction and/or reversal of NMB, and threshold analyses were carried out on a series of pairwise comparisons to establish how effective sugammadex needs to be to justify its cost. Results: The review of clinical effectiveness included four randomised active-control trials of sugammadex, nine randomised placebo-controlled trials and five studies in special populations. A total of 2132 titles and abstracts and 265 full-text publications were screened. The included trials indicated that sugammadex produces more rapid recovery from moderate or profound NMB than placebo or neostigmine. Median time to recovery from moderate blockade was 1.3–1.7 minutes for rocuronium + sugammadex, 21–86 minutes for rocuronium + placebo and 17.6 minutes for rocuronium + neostigmine. In profound blockade, median time to recovery was 2.7 minutes for rocuronium + sugammadex, 30 to > 90 minutes for rocuronium + placebo, and 49 minutes for rocuronium + neostigmine. Results for vecuronium were similar. In addition, recovery from NMB was faster with rocuronium reversed by sugammadex 16 mg/kg after 3 minutes (immediate reversal) than with succinylcholine followed by spontaneous recovery (median time to primary outcome 4.2 versus 7.1 minutes). The evidence base for modelling cost-effectiveness is very limited. However, assuming that the reductions in recovery times seen in the trials can be achieved in routine practice and can be used productively, sugammadex [2 mg/kg (4 mg/kg)] is potentially cost-effective at its current list price for the routine reversal of rocuronium-induced moderate (profound) blockade, if each minute of recovery time saved can be valued at approximately £2.40 (£1.75) or more. This is more likely to be achieved if any reductions in recovery time are in the operating room (estimated value of £4.44 per minute saved) rather than the recovery room (estimated value of £0.33 per minute saved). The results were broadly similar for rocuronium- and vecuronium-induced blockade. For rapid reversal of NMB it appeared that any reduction in morbidity from adopting sugammadex is unlikely to result in significant cost savings. Limitations: The evidence base was not large and many of the published trials were dose-finding and safety studies with very small sample sizes. Also, some relevant outcomes, in particular patient experience/quality of life and resources/costs used, were either not investigated or not reported. In addition, it is likely that the patients included in the efficacy trials were relatively young and in good general health compared with the overall surgical population. Regarding the economic evaluation, there appears to be no evidence linking measures of clinical efficacy to patients’ health-related quality of life and mortality risks. Conclusions: Sugammadex may be a cost-effective option compared with neostigmine + glycopyrrolate for reversal of moderate NMB and also provides the facility to recover patients from profound blockade. Rocuronium + sugammadex could be considered as a replacement for succinylcholine for rapid induction (and reversal) of NMB, although this may not be a cost-effective option in some types of patient at current list prices for sugammadex. Considerable uncertainties remain about whether the full benefits of sugammadex can be realised in clinical practice.

Marine Protected Areas (MPAs) are increasingly established globally as a spatial management tool to aid in conservation and fisheries management objectives. Assessing whether MPAs are having the desired effects on populations requires effective monitoring programs. A cornerstone of an effective monitoring program is an assessment of the statistical power of sampling designs to detect changes when they occur. We present a novel approach to power assessment that combines spatial point process models, integral projection models (IPMs) and sampling simulations to assess the power of different sample designs across a network of MPAs. We focus on the use of remotely operated vehicle (ROV) video cameras as the sampling method, though the results could be extended to other sampling methods. We use empirical data from baseline surveys of an example indicator fish species across three MPAs in California, USA as a case study. Spatial models simulated time series of spatial distributions across sites that accounted for the effects of environmental covariates, while IPMs simulated expected trends over time in abundances and sizes of fish. We tested the power of different levels of sampling effort (i.e., the number of 500-m ROV transects) and temporal replication (every 1-3 yr) to detect expected post-MPA changes in fish abundance and biomass. We found that changes in biomass are detectable earlier than changes in abundance. We also found that detectability of MPA effects was higher in sites with higher initial densities. Increasing the sampling effort had a greater effect than increasing sampling frequency on the time taken to achieve high power. High power was best achieved by combining data from multiple sites. Our approach provides a powerful tool to explore the interaction between sampling effort, spatial distributions, population dynamics, and metrics for detecting change in previously fished populations.