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Abstract A combination of life history traits and environmental conditions has been highlighted as the main drivers of avian breeding success. While drivers of breeding success are well known in some species, especially birds in northern, temperate regions; species in other parts of the world have received relatively little attention. In this study, we used a long‐term dataset on breeding success of tropical plovers from south‐west Madagascar to investigate whether nest survival changed over time and whether the drivers of nest survival were similar for multiple species breeding in the same arid habitat. In the 12‐year period of 2009–2020, we monitored 2077 nests for three species with different breeding strategies: 1185 nests of Kittlitz's plovers (Anarhynchus pecuarius) with a flexible breeding strategy and uniparental care; and 565 nests of white‐fronted plovers (A. marginatus) and 327 nests of Madagascar plovers (A. thoracicus) which both have biparental care. We found that nest survival was associated with a combination of clutch‐size, age of nest and year among the three plover species. In addition, annual variation in climatic conditions associated with El Niño/La Niña events were included in the most supported survival models for Kittlitz's and white‐fronted plovers, but the effects were not significant. Overall estimates of daily nest survival were similar for all three species: Kittlitz's plover: 0.950 ± 0.002 SE, Madagascar plover: 0.919 ± 0.007 SE, and white‐fronted plover: 0.862 ± 0.047 SE. Estimates of nest success for the breeding season, based on increases in daily nest survival with the clutch age during the incubation periods (26 days for Kittlitz's plovers and 29 days for Madagascar and white‐fronted plovers), were relatively low: Kittlitz's plover: 0.161 ± 0.056 SE, Madagascar plover: 0.287 ± 0.022 SE, and white‐fronted plover: 0.228 ± 0.019 SE. All three species had a combination of factors affecting nest survival, both environmental and life history traits.

Background: This study examines the impact of participating in a seven-week football programme on the personal well-being of male asylum seekers residing in contingency accommodation in the UK. Methods: This repeated measures study included a cohort of participants who engaged in weekly football sessions and completed a well-being questionnaire (ONS4) over a continuous seven-week period. Longitudinal linear regression analysis using generalized estimating equations (GEE) was used to assess the relationship between personal well-being and weekly minutes of football participation (M1). A second model incorporating the total number of non-football activity sessions in the past week as a covariate was also implemented (M2). Results: Of the 73 participants who completed the questionnaire, 23 responded twice or more across the study period and were subsequently included in the analysis. Results revealed that 2 h of football participation within 7 days significantly improved aspects of personal well-being when compared with no football participation, including improved life satisfaction, feeling life is worthwhile, and happiness. Both models demonstrated a shift from ‘low’ to ‘medium’ ONS4 categorical score. Anxiety levels remained unchanged regardless of participation and model. Conclusion: We provide important evidence on the potential benefits of football participation for promoting personal well-being among male asylum seekers residing in contingency accommodation.

Abstract Background For people at high risk of lung cancer, low-dose computed tomography (LDCT) is proposed as a method to reduce mortality. Methods Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analyses. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017, and then further extended to November 2021. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed. Results Nine RCTs, with up to 12.3 years of follow-up from randomisation, were included in the direct meta-analysis, which showed that LDCT screening was associated with a statistically significant decrease in lung cancer mortality (pooled relative risk (RR) 0.86, 95% confidence interval [CI] 0.77 to 0.96). There was a statistically non-significant decrease in all-cause mortality (pooled RR 0.98, 95% CI 0.95 to 1.01). The statistical heterogeneity for both outcomes was minimal. Network meta-analysis including the nine RCTs in the direct meta-analysis plus two further RCTs comparing CXR with usual care confirmed the size of the effect of LDCT on lung cancer mortality and that this was very similar irrespective of whether the comparator was usual care or CXR screening. Conclusions LDCT screening is effective in reducing lung cancer mortality in high-risk populations. The uncertainty of its effect on lung cancer mortality observed in 2018 has been much reduced with new trial results and updates to existing trials, emphasising the importance of updating systematic reviews. Although there are still a number of RCTs unreported or in progress, we predict that further evolution of summary mortality estimates is unlikely. The focus for debate now moves to resolving uncertainty about the cost-effectiveness of LDCT screening taking into account the balance between benefits and harms which occur in all screening programmes.

Global biodiversity loss is a major environmental concern. The wildlife on islands are particularly vulnerable to threats posed by alien predators, habitat loss and overexploitation. Effective conservation management of vulnerable species requires reliable information on vital population rates for all life stages and an understanding of key environmental drivers. However, demographic data are often not available for island populations before they decline or are extirpated. Here, we use Cormack–Jolly–Seber (CJS) models and 15 years of data for 1370 juveniles and 687 adults to estimate apparent survival for a genetically distinct resident population of Kentish plovers Charadrius alexandrinus on the island of Maio, Cabo Verde. We report two main findings. First, environmental conditions have a large effect on demographic performance since chicks that hatch during dry years experience a tenfold reduction in first‐year survival compared to chicks that hatch during wet years. Second, female and male plovers in Maio are expected to live for 7.41 ± 0.69 (mean ± SE) years and 6.75 ± 0.64 years, respectively, due to relatively high annual survival among comparable‐sized shorebirds. High adult survival thus could buffer the population against low reproductive success that this population has experienced over the last decade. Cabo Verde is typical of tropical islands with increased development that can impact native breeders and/or will accelerate habitat loss. Thus, more frequent droughts associated with climate change may exacerbate the prospects of native wildlife on many islands.

PurposeThe purpose of this study was to compare the effects of vertical (VPT), horizontal (HPT) and combined vertical and horizontal (V+HPT) plyometric training on sprint, jump and change of direction (COD) performance in adult male soccer players.MethodParticipants were randomly allocated into VPT (n = 8), HPT (n = 8) and V+HPT (n = 8) groups which undertook eight weeks of PT, executing 100 foot contacts per session, twice weekly.ResultsThough demonstrably effective, no specific one of the three applied programmes enhanced performance to a greater extent than another with only the 40 m sprint for the HPT group (mean difference = 0.07 s [HPT] vs. 0.04 s [VPT] and 0.04 s [V+HPT]) and the vertical jump for the V+HPT group (mean difference = 4.5 cm [V+HPT] vs. 4.0 cm [VPT] and 3.25 cm [HPT]) appearing to deviate from a uniform pattern of group level adaptation across the performance tests.ConclusionA total volume of 100 foot contacts per session, twice per week for eight weeks was sufficient to achieve the observed changes. Though jump and changing direction performance were enhanced, linear sprint performance was largely unchanged and so a more complete and intense programme may have been warranted. No method was superior to another in eliciting changes across these tests and a directionally-specific pattern of adaptation was not apparent.

Obesity, along with its associated health issues, is closely tied to lifestyle habits. While certain elements affecting childhood health, such as genetics and ethnicity, are beyond individuals' control, there exists modifiable lifestyle behaviours that can facilitate healthier living. This study employed multiple regression analysis to investigate the relationship between specific modifiable lifestyle behaviours and self-reported health. The independent variables considered included days of moderate to vigorous physical activity (MVPA), fruit and vegetable consumption, breakfast frequency, school night sleep duration, and non-school night sleep duration. These variables were chosen for their practical modifiability within participants' daily lives. The analysis revealed a highly significant overall model (F(13,11363) = 191.117, p < .001), explaining 17.9% of the variance in self-reported health. Notably, higher MVPA levels were associated with improved self-reported health (B = 0.136 to 0.730, p < .001). Additionally, regular breakfast consumption and increased fruit and vegetable intake exhibited positive associations with self-reported health (B = 0.113 to 0.377, p < .001), while girls reported lower self-reported health (B = -0.079, p < .001). School night sleep duration was positively linked to self-reported health (B = 0.071, p < .001). Furthermore, a dose-response relationship between MVPA, dietary habits, and health was identified. These findings hold substantial potential for public health campaigns to promote healthy behaviours and prevent chronic diseases in young individuals. It is imperative to emphasise that all the variables considered in this study are readily modifiable aspects of individuals' lives, offering a promising avenue for personal health and well-being enhancement.

Physical inactivity within an ageing population is an ongoing public health concern for policymakers. Engagement in sport forms a foundation of policy designed to encourage physical activity participation and improve health and wellbeing. This study aimed to (i) understand the extent to which older adults participate in sport and the (ii) correlates that predict this involvement within an English population sample of older adults. A further aim was (iii) to examine the extent in which sports participation may vary due to the opportunity provided across Active Partnerships in England. To address this, a multi-level analysis framed through COM-B was conducted of the 2021 English Active Lives dataset (i.e., during the COVID-19 pandemic). The Active Lives survey provides population-level insight into sport, exercise, and physical activity participation across England. It samples upwards of n = 180,000 participants beyond the age of 16 years and asks questions on factors that influence participation. Our findings drawn from a sample of n = 68,808 older adults (i.e., >60-years of age) indicate that when accounting for variation across regions sports participation was significantly predicted by age (β = -.246, p = .040) and multiple deprivation (β = .706, p = .030). Further, our analysis suggests sports participation across regions is associated with changes in the perceptions of opportunity to participate (β = -28.70, p = .001). As the UK transitions from the COVID-19 pandemic, findings have implications for the promotion of sports participation for older adults, in that local, regional, and national stakeholders must do more to change perceptions of social and physical opportunity within an ageing population. This may be achieved through adaptations to the recreational sporting landscape, raising awareness, and supportive policy changes on a national level.

BackgroundGiven growing hospital capacity pressures, persistent delayed discharges, and ongoing efforts to improve patient flow, the use of unconventional environments (newly created or repurposed areas for patient care) is becoming increasingly common. Despite this, little is known about individuals' experiences in providing or receiving care in these environments.ObjectivesThe objectives of this study were to: (1) describe the characteristics of three unconventional environments used to care for patients experiencing a delayed discharge, and (2) explore individuals' experiences with the three unconventional environments.MethodsThis was a multi-method qualitative study of three unconventional environments in Ontario, Canada. Data were collected through semi-structured interviews and observations. Participants included patients, caregivers, healthcare providers, and clinical managers who had experience with delayed discharges. In-person observations of two environments were conducted. Interviews were transcribed and notes from the observations were recorded. Data were coded and analyzed thematically.ResultsTwenty-nine individuals participated. Three themes were identified for unconventional environments: (1) implications on the physical safety of patients; (2) implications on staffing models and continuity of care; and, (3) implications on team interactions and patient care. Participants discussed how the physical set-up of some unconventional spaces was not conducive to patient needs, especially those with cognitive impairment. Limited space made it difficult to maintain privacy and develop social relationships. However, the close proximity of team members allowed for more focused collaborations regarding patient care and contributed to staff fulfilment. A smaller, consistent care team and access to onsite physicians seemed to foster improved continuity of care.ConclusionsThere is potential to learn from multi-stakeholder perspectives in unconventional environments to improve experiences and optimize patient care. Key considerations include keeping hallways and patient rooms clear, having communal spaces for activities and socialization, co-locating team members to improve interactions and access to resources, and ensuring a consistent care team.

Tropical islands harbour a disproportionally high number of endemic species, which face increasing threats due to habitat loss, disturbance and introduced alien predators. Long-term demographic studies are needed to understand how such threats may impact on population productivity. We report an investigation of a key demographic parameter, nest survival, over a 13-year period in a small ground-nesting shorebird on the island of Maio (Cabo Verde). Similar to many tropical islands, Maio is expected to face increased tourism, disturbance, and potential loss of nesting habitats. We monitored over 700 nests of the largest, year-round resident breeding population of Kentish plover in the Atlantic Ocean archipelago. Our work produced three important findings. First, we show that nest survival differed among the major habitats of the main breeding site, the Salinas do Porto Inglês, because nests in the salt-extraction area had higher daily survival rates DSR = 0.9654 ± 0.0076 SE than nests in grasslands DSR = 0.9557 ± 0.0038 SE. The salt-extraction is a dynamic habitat that is naturally regulated by rainfall and sea water inflow and managed with traditional methods for salt-extraction. Kentish plovers breed on small islets surrounded by salty water where mammalian predators may have restricted access. Second, we found that breeding densities of plovers decreased from 0.11 nests/ha to 0.03 nests/ha over 13 years. Last, we show that nest survival declined from 0.9784 ± 0.0107 in 2007 to 0.8967 ± 0.0401 in 2019. We suggest that the declining breeding density and nest survival may be driven by a combination of ecological factors including predation by native and introduced species, and by increased human disturbance. To help maintain sustainable levels of nest survival and to ensure long-term persistence of this Kentish plover population, we propose to incorporate traditional Salinas management into direct conservation actions, to reduce human disturbance and manage nest predators to help nest survival on tropical islands.

Abstract Background In attempt to improve continuity of patient care and reduce length of stay, hospitals have placed an increased focus on reducing delayed discharges through discharge planning. Several benefits and challenges to team-based approaches for discharge planning have been identified. Despite this, professional hierarchies and power dynamics are common challenges experienced by healthcare providers who are trying to work as a team when dealing with delayed discharges. The objective of this study was to explore what was working well with formal care team-based discharge processes, as well as challenges experienced, in order to outline how teams can function to better support transitions for patients experiencing a delayed discharge. Methods We conducted a descriptive qualitative study with hospital-based healthcare providers, managers and organizational leaders who had experience with delayed discharges. Participants were recruited from two diverse health regions in Ontario, Canada. In-depth, semi-structured interviews were conducted in-person, by telephone or teleconference between December 2019 and October 2020. All interviews were recorded and transcribed. A codebook was developed by the research team and applied to all transcripts. Data were analyzed inductively, as well as deductively through directed content analysis. Results We organized our findings into three main categories – (1) collaboration with physicians makes a difference; (2) leadership should meaningfully engage with frontline providers and (3) partnerships across sectors are critical. Regular physician engagement, as equal members of the team, was recommended to improve consistent communication, relationship building between providers, accessibility, and in-person communication. Participants highlighted the need for a dedicated senior leader who ensured members of the team were treated as equals and advocated for the team. Improved partnerships across sectors included the enhanced integration of community-based providers into discharge planning by placing more focus on collaborative practice, combined discharge planning meetings, and having embedded and physically accessible care coordinators in the hospital. Conclusions Team-based approaches for delayed discharge can offer benefits. However, to optimize how teams function in supporting these processes, it is important to consistently collaborate with physicians, ensure senior leadership engage with and seek feedback from frontline providers through co-design, and actively integrate the community sector in discharge planning.

Abstract Aim To inform the oversight of future clinical trials during a pandemic, we summarise the experiences of the Data Monitoring Committee (DMC) for the Randomised Evaluation of COVID therapy trial (RECOVERY), a large-scale randomised adaptive platform clinical trial of treatments for hospitalised patients with COVID-19. Methods and findings During the first 24 months of the trial (March 2020 to February 2022), the DMC oversaw accumulating data for 14 treatments in adults (plus 10 in children) involving > 45,000 randomised patients. Five trial aspects key for the DMC in performing its role were: a large committee of members, including some with extensive DMC experience and others who had broad clinical expertise; clear strategic planning, communication, and responsiveness by the trial principal investigators; data collection and analysis systems able to cope with phases of very rapid recruitment and link to electronic health records; an ability to work constructively with regulators (and other DMCs) to address emerging concerns without the need to release unblinded mortality results; and the use of videoconferencing systems that enabled national and international members to meet at short notice and from home during the pandemic when physical meetings were impossible. Challenges included that the first four treatments introduced were effectively ‘competing’ for patients (increasing pressure to make rapid decisions on each one); balancing the global health imperative to report on findings with the need to maintain confidentiality until the results were sufficiently certain to appropriately inform treatment decisions; and reliably assessing safety, especially for newer agents introduced after the initial wave and in the small numbers of pregnant women and children included. We present a series of case vignettes to illustrate some of the issues and the DMC decision-making related to hydroxychloroquine, dexamethasone, casirivimab + imdevimab, and tocilizumab. Conclusions RECOVERY’s streamlined adaptive platform design, linked to hospital-level and population-level health data, enabled the rapid and reliable assessment of multiple treatments for hospitalised patients with COVID-19. The later introduction of factorial assessments increased the trial’s efficiency, without compromising the DMC’s ability to assess safety and efficacy. Requests for the release of unblinded primary outcome data to regulators at points when data were not mature required significant efforts in communication with the regulators by the DMC to avoid inappropriate early trial termination.

Self-report measures are widely used for research and clinical assessment of adults with autism spectrum disorder. However, there has been little research examining the convergence of self- and informant-report in this population. This study examined agreement between 40 pairs of adults with autism spectrum disorder and their caregivers on measures of symptom severity, daily living skills, quality of life, and unmet service needs. In addition, this study examined the predictive value of each reporter for objective independent living and employment outcomes. Caregiver and self-report scores were significantly positively correlated on all measures (all r's >0.50). Results indicated that there were significant differences between reporter ratings of daily living skills, quality of life, and unmet service needs, but no significant differences between ratings of symptom severity. Combining caregiver-report and self-report measures provided significantly higher predictive value of objective outcomes than measures from a single reporter. These findings indicate that both informants provide valuable information and adults with autism spectrum disorder should be included in reporting on their own symptoms and experiences. Given that two reporters together were more predictive of objective outcomes; however, a multi-informant assessment may be the most comprehensive approach for evaluating current functioning and identifying service needs in this population.

Abstract Background Low cardiorespiratory fitness (CRF) is associated with the development of cardiovascular diseases during childhood, adolescence and older ages. The purpose of the study was to investigate associations between fatness, hemodynamic characteristics and secondary time with CRF in primary school-aged children. Methods Height, weight, body mass index (BMI), blood pressure (BP), heart rate (HR), CRF (20 m shuttle-run) and sedentary time were measured for 105 children (categorized as normal, overweight, obese). The independent sample t-test checked for differences and one-way ANOVA—Post Hoc Test and stepwise linear regression analysis assessed the 20 m shuttle-run performance predictors. Results There was a statistically significant difference in CRF between boys and girls. There was a statistically significant difference between (p 0.3; p

BackgroundThe COVID-19 pandemic caused disruptions across healthcare systems globally exposing the precarious state of patient engagement across all levels of healthcare. While evidence is emerging to describe how engagement was affected across various settings, insights about how some organizations at the policy and practice level of healthcare were able to sustain or adapt patient engagement activities is lacking.ObjectiveThis paper addresses the following research question: "How were healthcare, government, and patient partner organizations able to sustain or adapt patient engagement activities during the COVID-19 pandemic?"MethodsA qualitative descriptive study was conducted to understand how patient engagement activities were maintained or adapted in a variety of healthcare, government, and patient partner organizations in Canada throughout the pandemic. This analysis was part of a larger qualitative, multiple case study where one-to-one interviews were conducted with organizational leaders, managers and patient partners.ResultsThe following themes were identified as key aspects of maintaining or adapting patient engagement activities: 1) having an embedded organizational culture of patient engagement; 2) adapting patient engagement activities to focus on COVID-19 response efforts; 3) having patient partners who exercised leadership and advocacy to support patient care and experiences during the pandemic; and 4) leveraging virtual technology as a communication tool to engage patient partners.ConclusionThis paper highlights important insights that may be useful to other health care organizations on how to sustain or adapt patient engagement activities during a healthcare crisis. Having patient engagement embedded within an organization's culture supported by, but not limited to, infrastructure, resources, investments in dedicated staff and patient partner leadership, and communication strategies and tools enabled continued patient engagement activities during the pandemic.

Purpose The way coaching cues are worded can impact on the quality with which a subsequent motor skill is executed. However, there have been few investigations on the effect of coaching cues on basic motor skill performance in youths. Method Across several international locations, a series of experiments were undertaken to determine the effect of external coaching cues (EC), internal coaching cues (IC), analogies with a directional component (ADC) and neutral control cues on sprint time (20 m) and vertical jump height in youth performers. These data were combined using internal meta-analytical techniques to pool results across each test location. This approach was amalgamated with a repeated-measures analysis to determine if there were any differences between the ECs, ICs and ADCs within the different experiments. Results 173 participants took part. There were no differences between the neutral control and experimental cues in any of the internal meta-analyses except where the control was superior to the IC for vertical jump (d = -0.30, [-0.54, -0.05], p = 0.02). Just three of eleven repeated-measures analyses showed significant differences between the cues at each experimental location. Where significant differences were noted, the control cue was most effective with some limited evidence supporting the use of ADCs (d = 0.32 to 0.62). Conclusion These results suggest the type of cue or analogy provided to a youth performer has little subsequent effect on sprint or jump performance. Accordingly, coaches might take a more specific approach that is suited to the level or preferences of a particular individual.

Abstract Background Vascular prevention trials typically use dichotomous event outcomes although this may be inefficient statistically and gives no indication of event severity. We assessed whether ordinal outcomes would be more efficient and how to best analyse them. Methods Chief investigators of vascular prevention randomised controlled trials that showed evidence of either benefit or harm, or were included in a systematic review that overall showed benefit or harm, shared individual participant data from their trials. Ordered categorical versions of vascular event outcomes (such as stroke and myocardial infarction) were analysed using 15 statistical techniques and their results then ranked, with the result with the smallest p-value given the smallest rank. Friedman and Duncan’s multiple range tests were performed to assess differences between tests by comparing the average ranks for each statistical test. Results Data from 35 trials (254,223 participants) were shared with the collaboration. 13 trials had more than two treatment arms, resulting in 59 comparisons. Analysis approaches (Mann Whitney U, ordinal logistic regression, multiple regression, bootstrapping) that used ordinal outcome data had a smaller average rank and therefore appeared to be more efficient statistically than those that analysed the original binary outcomes. Conclusions Ordinal vascular outcome measures appear to be more efficient statistically than binary outcomes and provide information on the severity of event. We suggest a potential role for using ordinal outcomes in vascular prevention trials.

Abstract Objectives Health services to date have inadequately addressed the physical and mental health needs of patients with medically unexplained symptoms. This qualitative study evaluates a piloted facilitated support group (FSG) developed for patients with medically unexplained symptoms to inform recommendations and resources for this patient population. Methods Using a qualitative descriptive design, we conducted and thematically analyzed semi-structured interviews with participants (n = 8) and facilitators (n = 4) to explore their experiences of the facilitated support group. Common themes that captured strengths and challenges of the facilitated support group were identified. Results The following key themes were identified through analysis of the data: Participants described 1) feeling validated through sharing similar experiences with peers; 2) learning practical symptom management and coping strategies; and 3) gaining new perspectives for navigating conversations with PCPs. Conclusions Our findings show that a facilitated support group may provide additional forms of support and resources for patients with medically unexplained symptoms, filling a gap in currently available clinical care offered by health care professionals. Potential implications: This paper highlights lessons learned that can inform the design and delivery of future supports and resources directed toward optimizing patient care for this underserved patient population. Our findings are relevant to those who are involved in direct patient care or involved in designing and implementing self-management programs.

Abstract Background The CRASH-3 trial hypothesised that timely tranexamic acid (TXA) treatment might reduce deaths from intracranial bleeding after traumatic brain injury (TBI). To explore the mechanism of action of TXA in TBI, we examined the timing of its effect on death. Methods The CRASH-3 trial randomised 9202 patients within 3 h of injury with a GCS score ≤ 12 or intracranial bleeding on CT scan and no significant extracranial bleeding to receive TXA or placebo. We conducted an exploratory analysis of the effects of TXA on all-cause mortality within 24 h of injury and within 28 days, excluding patients with a GCS score of 3 or bilateral unreactive pupils, stratified by severity and country income. We pool data from the CRASH-2 and CRASH-3 trials in a one-step fixed effects individual patient data meta-analysis. Results There were 7637 patients for analysis after excluding patients with a GCS score of 3 or bilateral unreactive pupils. Of 1112 deaths, 23.3% were within 24 h of injury (early deaths). The risk of early death was reduced with TXA (112 (2.9%) TXA group vs 147 (3.9%) placebo group; risk ratio [RR] RR 0.74, 95% CI 0.58–0.94). There was no evidence of heterogeneity by severity (p = 0.64) or country income (p = 0.68). The risk of death beyond 24 h of injury was similar in the TXA and placebo groups (432 (11.5%) TXA group vs 421 (11.7%) placebo group; RR 0.98, 95% CI 0.69–1.12). The risk of death at 28 days was 14.0% in the TXA group versus 15.1% in the placebo group (544 vs 568 events; RR 0.93, 95% CI 0.83–1.03). When the CRASH-2 and CRASH-3 trial data were pooled, TXA reduced early death (RR 0.78, 95% CI 0.70–0.87) and death within 28 days (RR 0.88, 95% CI 0.82–0.94). Conclusions Tranexamic acid reduces early deaths in non-moribund TBI patients regardless of TBI severity or country income. The effect of tranexamic acid in patients with isolated TBI is similar to that in polytrauma. Treatment is safe and even severely injured patients appear to benefit when treated soon after injury. Trial registration ISRCTN15088122 , registered on 19 July 2011; NCT01402882 , registered on 26 July 2011.

Adult survival is a key component of population dynamics, and understanding variation in and the drivers of adult survival rates and longevity is critical for ecological and evolutionary studies, as well as for conservation biology and practice. Tropical species of landbirds are often selected to have higher adult survival due to high nest predation rates, but it is unclear if the same patterns occur in other avian lineages with different life history strategies. Here, we investigate adult survival of three sympatrically breeding species of shorebirds in south‐west Madagascar: the endemic and endangered Madagascar plover Charadrius thoracicus and two more widely distributed African species: the white‐fronted plover C. marginatus and the Kittlitz's plover C. pecuarius. Using mark–recapture data from 1843 individuals breeding at an intensely monitored saltmarsh over a 13‐year period, we estimated annual rates of apparent survival (φ) corrected for encounter probability. Adult apparent survival rates were high for all three species (mean ± SE): Madagascar (φ = 0.899 ± 0.010) and white‐fronted plovers (φ = 0.923 ± 0.008). Kittlitz's plovers showed a difference between the first (φ1 = 0.719 ± 0.026) and subsequent transitions (φ2+ = 0.892 ± 0.014), suggesting that transient breeders are common in this species. For birds first captured as adults, these survival estimates translate to life expectancies of 9.72 (±1.11) years in Kittlitz's plovers, 9.36 (±0.98) years in Madagascar plovers and 12.48 (±1.32) in white‐fronted plovers. We hypothesise that a long lifespan could be an adaptation arising from the unique climatic pressures on the island of Madagascar that would otherwise lead to reduced fitness. However, long lifespans may not sufficiently compensate for a reduction in breeding opportunities due to possible climatic disruption in the future. Consequently, at least two of these plover species seem vulnerable to ongoing habitat destruction and changing climate cycles.

The current UK physical activity guidelines recommend that adults aged 19 to 65 years perform activity to strengthen muscle and bone a minimum of twice weekly. The number of adults meeting strengthening activity guidelines is lower than for aerobic activity, but estimates vary between studies partly due to differences in how muscle-strengthening activity is defined. We aimed to provide estimates for strengthening activity prevalence in English adults based on a nationally representative sample of n = 253,423 18-65-year-olds. We attempted to quantify the variation in estimates attributable to differences in the way strengthening activity is defined. Finally, we aim to provide a brief descriptive epidemiology of the factors associated with strengthening activity. Adults met guidelines for aerobic activity if they reported the activity equivalent to >150 min/week moderate-intensity exercise. Respondents met strengthening guidelines if they reported at least two bouts per week of strengthening activity. We defined strengthening activity, first, according to criteria used in the Health Survey for England (HSE). Second, we counted bouts of strengthening activities for which we could find evidence of health-related benefits (Evidence). Third, we included bouts of strengthening activity as defined in current UK physical activity guidelines (Guideline). Two-thirds (67%) of adults met guidelines for aerobic activity (69% of men, 65% of women). Less than one-third (29% of men and 24% of women) met guidelines for the HSE definition of strengthening activity. Under the Evidence definition, 16% of men and 9% of women met strengthening guidelines. Using the most-stringent definition (Guideline) just 7.3% of men and 4.1% of women achieved the recommendations for strengthening activity. We found females and older adults (50-65 years) were less likely to meet guidelines for aerobic, strengthening, and combined aerobic plus strengthening activity. The prevalence of meeting activity guidelines was lower in adults from more deprived areas (compared with the least deprived); Adults with lower academic qualifications (Level 1) were less likely to meet activity guidelines than those educated to Level 4 (Degree Level) or higher. Having a limiting disability was associated with a lower prevalence of meeting activity guidelines. Associations between socio-demographic measures and the prevalence of adults meeting activity guidelines were stronger for strengthening activity than for aerobic 51(or combined aerobic plus strengthening) activity Compared with aerobic activity, fewer adults engage in strengthening activity regardless of how it is defined. The range in estimates for how many adults meet strengthening activity guidelines can be explained by variations in the definition of 'strengthening' that are used and the specific sports or activities identified as strengthening exercise. When strengthening activity is included, the proportion of English adults meeting current physical activity guidelines could be as high as 1 in 3 but possibly as low as just 1 in 20. A harmonized definition of strengthening activity, that is aligned with physical activity guidelines, is required to provide realistic and comparable prevalence estimates.

© 2015 The Authors.Describing, understanding, and modulating the function of the cell require elucidation of the structures of macromolecular assemblies. Here, we describe an integrative method for modeling heteromeric complexes using as a starting point d

The immune system can influence social motivation with potentially dire consequences for group-housed production animals, such as pigs. The aim of this study was to test the effect of a controlled immune activation in group-housed pigs, through an injection with lipopolysaccharide (LPS) and an intervention with ketoprofen on centrality parameters at the individual level. In addition, we wanted to test the effect of time relative to the injection on general network parameters in order to get a better understanding of changes in social network structures at the group level. 52 female pigs (11–12 weeks) were allocated to four treatments, comprising two injections: ketoprofen-LPS (KL), ketoprofen-saline (KS), saline-LPS (SL) and saline-saline (SS). Social behaviour with a focus on damaging behaviour was observed continuously in 10 × 15 min bouts between 0800 am and 1700 pm 1 day before (baseline) and two subsequent days after injection. Activity was scan-sampled every 5 min for 6 h after the last injection in the pen. Saliva samples were taken for cortisol analysis at baseline and at 4, 24, 48, 72 h after the injections. A controlled immune activation affected centrality parameters for ear manipulation networks at the individual level. Lipopolysaccharide-injected pigs had a lower in-degree centrality, thus, received less interactions, 2 days after the challenge. Treatment effects on tail manipulation and fighting networks were not observed at the individual level. For networks of manipulation of other body parts, in-degree centrality was positively correlated with cortisol response at 4 h and lying behaviour in the first 6 h after the challenge in LPS-injected pigs. Thus, the stronger the pigs reacted to the LPS, the more interactions they received in the subsequent days. The time in relation to injection affected general network parameters for ear manipulation and fighting networks at the group level. For ear manipulation networks, in-degree centralisation was higher on the days following injection, thus, certain individuals in the pen received more interactions than the rest of the group compared to baseline. For fighting networks, betweenness decreased on the first day after injection compared to baseline, indicating that network connectivity increased after the challenge. Networks of tail manipulation and manipulation of other body parts did not change on the days after injection at the group level. Social network analysis is a method that can potentially provide important insights into the effects of sickness on social behaviour in group-housed pigs.

Rosenberg's scale (RSES) is widely used to assess global self-esteem (SE) in adults and adolescents but is not validated for children 0.05); but were significantly reduced in children aged 9–10 and 11–12 years compared to children aged 7–8 years. The global SE score was significantly correlated (r = 0.51; P < 0.001) with LS. The current version of the CRSES can reliably examine global SE in children aged 7–12 years; extending the use of the RSES to allow tracking across the life course.

Cytokines are cell signalling proteins that mediate a number of different physiological responses. The accurate measurement of cytokine profiles is important for a variety of diagnostic and prognostic scenarios in relation to animal health and welfare. Simultaneous quantification of cytokine profiles in a single sample is now possible using fluorescent microsphere immunoassays (FMIA). We describe the development and validation of a novel multiplex assay using the Bio-Plex® 200 system to quantify cytokines in five different porcine tissues (brain, placenta, synovial tissue and fluid, plasma). The cytokine profiles are both tissue, and research hypothesis, -dependent but include Interleukin-1beta (IL-1β), Interleukin-4 (IL-4), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10) and Tumor necrosis factor (TNF-α).This methods paper is reported in two parts: the development of a FMIA for porcine tissues and validation of pre-treatment for optimal cytokine recovery in porcine brain, placenta, synovial tissue and plasma. Validation steps are critical in ensuring an assay is suitable for novel sample types.This technique advances traditional ELISAs by: • FMIA provides insight into the profiles of multiple porcine cytokines in certain situations (e.g. disease, parturition). • Use of the Bio-Plex® 200 system to investigate novel sample types, including brain, placenta and synovial tissue. • Multiplexing utilises a fraction of the sample volume compared with multiple ELISAs. Method name: Fluorescent microsphere immunoassay (FMIA), Keywords: Porcine, Multiplex, Cytokine, FMIA, Brain, Placenta, Synovial tissue, Synovial fluid, Plasma, Validation

Impaired walking ability in terms of slight or definite defects is more common in broiler production than lameness that obviously hinders movement, but it has received limited scientific attention. This study aimed to compare behavior of conventional broilers with impaired walking ability (assessed as gait score (GS) 2) with those walking normally (GS0) and those with only a slight gait defect (GS1). Behavior in the home environment was registered, and an analgesic intervention to quantify changes in time budgets indicating pain relief was applied. The study included 192 Ross 308 broilers. On day 27 of age, the birds were distributed as evenly as possible into birds of GS0 and GS2 of each sex based on obtained gait score. Following this, each experimental bird was housed with 3 companion birds. On days 30 and 32 of age, the behavior in the home pens was recorded. All experimental birds were injected with the NSAID carprofen on one of the 2 d and saline on the other. The statistical analyses used the GS scored on the day of recording as explanatory factor. Compared to GS0 birds, GS2 birds tended to be more inactive (mean (CI): 4,193 (3,971–4416) vs. 4,005 (3,753–4,257) s; P = 0.074), spent more time sitting while feeding (306 (266–353) vs. 213 (180–251) s; P = 0.026), were less likely to perch (probability: 0.78 (0.69–0.85) vs. 0.91 (0.85–0.95); P = 0.012), and spent less time performing comfort behavior (749 (689–814) s vs. 875 (792–967) s; P = 0.043). Compared to GS1 birds, GS2 birds spent more time inactive (GS1: 4,022 (3,818–4225) s; P = 0.027), less time foraging (289 (253–329) vs. 347 (309–388) s; P = 0.047), and were less likely to perch (GS1: 0.90 (0.86–0.93); P = 0.001). For some of these behavioral variables, administration of carprofen led to behavioral changes across the GSs, which may suggest that the behavioral expression of the broilers was limited by pain. These findings are of relevance to animal welfare, but the underlying causes are still not fully clarified.

Poor health is a risk factor for damaging behaviors, but the mechanisms behind this link are unknown. Injection of pigs with lipopolysaccharide (LPS) can be used to model aspects of poor health. Recent studies have shown that LPS-injected pigs perform more tail- and ear-directed behavior compared to saline-injected pigs and suggest that pro-inflammatory cytokines may play a role in these behaviors. The aims of this study were to test the effect of LPS on the social behavior of pigs and the neurotransmitters and modulators in their brains and to test the effect of a nonsteroidal anti-inflammatory drug on the effects of LPS. Fifty-two female pigs (11–12 weeks) were allocated to four treatments comprising two injections: saline–saline (SS), saline–LPS (SL), ketoprofen–saline (KS), and ketoprofen–LPS (KL). Activity was scan-sampled every 5 min for 6 h after the last injection in the pen. Social behavior was observed continuously in 10 × 15-min bouts between 8 a.m. and 5 p.m. 1 day before (baseline) and 1 and 2 days after the injection. Saliva was analyzed for cortisol and plasma for tryptophan and kynurenine. The frontal cortex, hippocampus, hypothalamus, and brain stem were sampled 72 h after the injection and analyzed for cytokines and monoamines. LPS activated the HPA axis and decreased the activity within 6 h after the injection. Ketoprofen lowered the effect of LPS on cortisol release and attenuated the behavioral signs of sickness in challenged pigs. SL pigs manipulated the ears of their pen mates significantly longer than SS pigs 2 days after the injection. LPS had no observed effect on IFN-γ, TNF-α, and IL-18. At 72 h after the injection, plasma tryptophan was depleted in SL pigs, and tryptophan and kynurenine concentrations in the frontal cortex and brain stem of SL pigs were significantly lower compared to those in SS pigs. Dopamine concentrations in the hypothalamus of SL pigs were significantly lower compared to those in SS pigs. Serotonin concentrations in the hypothalamus and noradrenaline concentrations in the hippocampus of SL pigs were significantly lower compared to those in KL pigs. In conclusion, LPS influenced the different neurotransmitters and modulators in the brain that are hypothesized to play an important role in the regulation of mood and behavior.

The aim of this study was to evaluate the impact on muscle strength, aerobic fitness and body composition, of replacing the physical education (PE) class of Colombian adolescents with resistance or aerobic training. 120 tanner stage 3 adolescents attending a state school were randomized to resistance training, aerobic training, or a control group who continued to attend a weekly 2- hour PE class for 16 weeks. The resistance training and aerobic training groups participated in twice weekly supervised after-school exercise sessions of < 1 hour instead of their PE class. Sum of skinfolds, lean body mass (bioelectrical impedance analysis), muscular strength (6 repetition maximum (RM)) bench press, lateral pulldown and leg press) and estimated cardiorespiratory fitness (multistage 20 meter shuttle run) were assessed at pre and post intervention. Complete data were available for n = 40 of the resistance training group, n = 40 of the aerobic training group and n = 30 PE (controls). Resistance training attenuated increases in sum of skinfolds compared with controls (d = 0.27, [0.09-0.36]). We found no significant effect on lean body mass. Resistance training produced a positive effect on muscle strength compared with both controls (d = 0.66 [.49-.86]) and aerobic training (d = 0.55[0.28-0.67]). There was a positive effect of resistance training on cardiorespiratory fitness compared with controls (d = 0.04 [-0.10-0.12]) but not compared with aerobic training (d = 0.24 [0.10-0.36]). Replacing a 2-hour PE class with two 1 hour resistance training sessions attenuated gains in subcutaneous adiposity, and enhanced muscle strength and aerobic fitness development in Colombian youth, based on a median attendance of approximately 1 session a week. Further research to assess whether adequate stimuli for the development of muscular fitness exists within current physical education provision is warranted.

BackgroundThe COVID-19 pandemic has had a devastating impact on healthcare systems and care delivery, changing the context for patient and family engagement activities. Given the critical contribution of such activities in achieving health system quality goals, we undertook to address the question: What is known about work that has been done on patient engagement activities during the pandemic?ObjectiveTo examine peer-reviewed and grey literature to identify the range of patient engagement activities, broadly defined (inclusive of engagement to support clinical care to partnerships in decision-making), occurring within health systems internationally during the first six months of the COVID-19 pandemic, as well as key barriers and facilitators for sustaining patient engagement activities during the pandemic.MethodsThe following databases were searched: Medline, Embase and LitCOVID; a search for grey literature focused on the websites of professional organizations. Articles were required to be specific to COVID-19, describe patient engagement activities, involve a healthcare organization and be published from March 2020 to September 2020. Data were extracted and managed using Microsoft Excel. A content analysis of findings was conducted.ResultsTwenty-nine articles were included. Few examples of more genuine partnership with patients were identified (such as co-design and organizational level decision making); most activities related to clinical level interactions (e.g. virtual consultations, remote appointments, family visits using technology and community outreach). Technology was leveraged in almost all reported studies to interact or connect with patients and families. Five main descriptive categories were identified: (1) Engagement through Virtual Care; (2) Engagement through Other Technology; (3) Engagement for Service Improvements/ Recommendations; (4) Factors Impacting Patient Engagement; and (5) Lessons Learned though Patient Engagement.ConclusionsEvidence of how healthcare systems and organizations stayed connected to patients and families during the pandemic was identified; the majority of activities involved direct care consultations via technology. Since this review was conducted over the first six months of the pandemic, more work is needed to unpack the spectrum of patient engagement activities, including how they may evolve over time and to explore the barriers and facilitators for sustaining activities during major disruptions like pandemics.

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.