Randomised controlled trials in pre-hospital trauma : a systematic mapping review

Acknowledgements The authors thank Paul Manson (HSRU Information Scientist) for help with the database searches, Professor Graeme MacLennan for advice on categorising adaptive design trials, and Professor Marion Campbell for commenting on a draft version of the manuscript. Funding statement RL held an NHS Research Scotland Fellowship during the delivery of this project. The Health Services Research Unit, Institute of Applied Health Sciences (University of Aberdeen), is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no involvement in study design, collection, analysis and interpretation of data, reporting or the decision to publish.Peer reviewedPublisher PD

Migrating Mule Deer: Effects of Anthropogenically Altered Landscapes

Background: Migration is an adaptive strategy that enables animals to enhance resource availability and reduce risk of predation at a broad geographic scale. Ungulate migrations generally occur along traditional routes, many of which have been disrupted by anthropogenic disturbances. Spring migration in ungulates is of particular importance for conservation planning, because it is closely coupled with timing of parturition. The degree to which oil and gas development affects migratory patterns, and whether ungulate migration is sufficiently plastic to compensate for such changes, warrants additional study to better understand this critical conservation issue. Methodology/Principal Findings: We studied timing and synchrony of departure from winter range and arrival to summer range of female mule deer (Odocoileus hemionus) in northwestern Colorado, USA, which has one of the largest natural-gas reserves currently under development in North America. We hypothesized that in addition to local weather, plant phenology, and individual life-history characteristics, patterns of spring migration would be modified by disturbances associated with natural-gas extraction. We captured 205 adult female mule deer, equipped them with GPS collars, and observed patterns of spring migration during 2008–2010. Conclusions/Significance: Timing of spring migration was related to winter weather (particularly snow depth) and access to emerging vegetation, which varied among years, but was highly synchronous across study areas within years. Additionally, timing of migration was influenced by the collective effects of anthropogenic disturbance, rate of travel, distance traveled, and body condition of adult females. Rates of travel were more rapid over shorter migration distances in areas of high natural-gas development resulting in the delayed departure, but early arrival for females migrating in areas with high development compared with less-developed areas. Such shifts in behavior could have consequences for timing of arrival on birthing areas, especially where mule deer migrate over longer distances or for greater durations

Climate change and human health: impacts, vulnerability and public health.

It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases in the atmosphere arising from the combustion of fossil fuels. Climate change may affect health through a range of pathways, for example as a result of increased frequency and intensity of heat waves, reduction in cold related deaths, increased floods and droughts, changes in the distribution of vector-borne diseases and effects on the risk of disasters and malnutrition. The overall balance of effects on health is likely to be negative and populations in low-income countries are likely to be particularly vulnerable to the adverse effects. The experience of the 2003 heat wave in Europe shows that high-income countries may also be adversely affected. Adaptation to climate change requires public health strategies and improved surveillance. Mitigation of climate change by reducing the use of fossil fuels and increasing a number of uses of the renewable energy technologies should improve health in the near-term by reducing exposure to air pollution

Beyond "what works": A mixed-methods study of intervention effect modifiers in the Good Behavior Game

This mixed‐methods study examines two moderators of the impact of the Good Behavior Game—implementation variability, participant risk status, and the interaction between them—as predictors of behavioral and academic outcomes. Quantitative data from 38 primary schools were utilized, with outcome data collected at baseline and 2‐year follow‐up. Behavior (disruptive behavior, prosocial behavior, and concentration problems) was assessed via the Teacher Observation of Classroom Adaptation Checklist. Reading attainment was assessed via national teacher assessment scores, and the Hodder Group Reading Test. Implementation fidelity/quality data were collected via independent observations. Participant risk status was modeled using a cumulative risk index. Multilevel modeling revealed that higher levels of fidelity/quality were associated with improved overall reading scores (d = 0.203–225), but worsening disruptive behavior among high‐risk students (d = 0.560). Thematic analysis of qualitative interview data collected from 20 teachers identified six groups of at‐risk students who were perceived to experience differential effects, and five key mechanisms underpinning these

Climate change and human health: impacts, vulnerability, and mitigation.

It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases in the atmosphere arising from the combustion of fossil fuels. Climate change may affect health through a range of pathways--eg, as a result of increased frequency and intensity of heat waves, reduction in cold-related deaths, increased floods and droughts, changes in the distribution of vector-borne diseases, and effects on the risk of disasters and malnutrition. The overall balance of effects on health is likely to be negative and populations in low-income countries are likely to be particularly vulnerable to the adverse effects. The experience of the 2003 heat wave in Europe shows that high-income countries might also be adversely affected. Adaptation to climate change requires public-health strategies and improved surveillance. Mitigation of climate change by reducing the use of fossil fuels and increasing the use of a number of renewable energy technologies should improve health in the near term by reducing exposure to air pollution

The impact of trial stage, developer involvement and international transferability on universal social and emotional learning programme outcomes: a meta-analysis

This study expands upon the extant prior meta-analytic literature by exploring previously theorised reasons for the failure of schoolbased, universal social and emotional learning (SEL) programmes to produce expected results. Eighty-nine studies reporting the effects of school-based, universal SEL programmes were examined for differential effects on the basis of: (1) stage of evaluation (efficacy or effectiveness); (2) involvement from the programme developer in the evaluation (led, involved, independent); and (3) whether the programme was implemented in its country of origin (home or away). A range of outcomes were assessed including: social-emotional competence, attitudes towards self, pro-social behaviour, conduct problems, emotional distress, academic achievement and emotional competence. Differential gains across all three factors were shown, although not always in the direction hypothesised. The findings from the current study demonstrate a revised and more complex relationship between identified factors and dictate major new directions for the field

The costs of preventing and treating chagas disease in Colombia

Background: The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy. Methods: Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation. Findings: The mean cost per house per entomological survey was $4.4 (in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between$46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is$1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care. Conclusion: Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.Wellcome Trus

Flexibility within the Heads of Muscle Myosin-2 Molecules

We show that negative-stain electron microscopy and image processing of nucleotide-free (apo) striated muscle myosin-2 subfragment-1 (S1), possessing one light chain or both light chains, is capable of resolving significant amounts of structural detail. The overall appearance of the motor and the lever is similar in rabbit, scallop and chicken S1. Projection matching of class averages of the different S1 types to projection views of two different crystal structures of apo S1 shows that all types most commonly closely resemble the appearance of the scallop S1 structure rather than the methylated chicken S1 structure. Methylation of chicken S1 has no effect on the structure of the molecule at this resolution: it too resembles the scallop S1 crystal structure. The lever is found to vary in its angle of attachment to the motor domain, with a hinge point located in the so-called pliant region between the converter and the essential light chain. The chicken S1 crystal structure lies near one end of the range of flexion observed. The Gaussian spread of angles of flexion suggests that flexibility is driven thermally, from which a torsional spring constant of ~ 23 pN·nm/rad2 is estimated on average for all S1 types, similar to myosin-5. This translates to apparent cantilever-type stiffness at the tip of the lever of 0.37 pN/nm. Because this stiffness is lower than recent estimates from myosin-2 heads attached to actin, we suggest that binding to actin leads to an allosteric stiffening of the motor–lever junction