What is the role of prokinetic agents for constipation?

Erythromycin has a limited role in treating pediatric patients (strength of recommendation [SOR]: B, limited-quality, patient-oriented evidence). Tegaserod and cisapride are the only prokinetic agents available for constipated adults (SOR: A, consistent, good-quality, patient-oriented evidence for tegaserod; SOR: B, for cisapride), but cardiovascular risk restricts prescribing of both medications

Predictors of responsivity to language intervention : findings from a RCT

Logistic regression analyses were carried out on the pre- and blind-assessed post-intervention language outcome measures for 124 children aged 6-11 years with primary language impairment randomised to language therapy who received three 30-40 minute sessions per week in mainstream schools over fifteen weeks. Only the model for binary gains (made progress/did not make progess) for receptive language was significant, with gender and case status (specific expressive versus mixed receptive-expressive impairment) significant predictors. Non-verbal IQ score was not a significant predictor of responsivity to intervention. Implications for the relationship between non-verbal development and primary language impairment and for intervention are discussed

Contribution of walking to school to individual and population moderate-vigorous intensity physical activity

PURPOSE: This study estimated the contribution of walking to/from school to objectively measured daily moderate-vigorous intensity physical activity (MVPA) in individuals and populations. METHODS: MEDLINE, PsycINFO and SPORTDiscus were systematically searched up to February 2015. Two reviewers independently screened titles/abstracts/full-text articles, and assessed study quality. RESULTS: Of 2430 records, 116 were eligible for full-text screening. Twelve studies met the inclusion criteria of reporting objectively obtained measures of MVPA (total and while walking to/from school) in children and adolescents. The weighted mean MVPA accumulated in walking to and from school was 17 minutes per day in primary school pupils (9 samples, n=3422) and 13 minutes per day in high school pupils (4 samples, n=2600). Pooled analysis suggested that walking to and from school contributed 23% and 36% of MVPA on schooldays in primary school age children and high school pupils, respectively. All included studies were of high methodological quality. CONCLUSIONS: Walking to and from school makes a meaningful contribution to individual schoolday MVPA for active commuters in western countries. Since schooldays represent only around half of all days, and prevalence of walking to school is low in many countries, the contribution of walking to school to population MVPA is probably low

Item selection and application in Higher Education

Over the past ten years the use of computer assisted assessment in Higher Education (HE) has grown. The majority of this expansion has been based around the application of multiple-choice items (Stephens and Mascia, 1997). However, concern has been expressed about the use of multiple choice items to test higher order skills. The Tripartite Interactive Assessment Development (TRIAD) system (Mackenzie, 1999) has been developed by the Centre for Interactive Assessment Development (CIAD) at the University of Derby. It is a delivery platform that allows the production of more complex items. We argue that the use of complex item formats such as those available in TRIADs could enhance validity and produce assessments with features not present in pencil and paper tests (cf. Huff and Sireci, 2001). CIAD was keen to evaluate tests produced in TRIADs and so sought the aid of the National Foundation for Educational Research (NFER). As part of an initial investigation a test was compiled for a year one Systems Analysis module. This test was produced by the tutor (in consultation with CIAD) and contained a number of item types; both multiple-choice items and complex TRIADs items. Data from the test were analysed using Classical Test Theory and Item Response Theory models. The results of the analysis led to a number of interesting observations. The multiple-choice items showed lower reliability. This was surprising since these items had been mainly obtained from published sources, with few written by the test constructor. The fact that the multiple-choice items showed lower reliability compared to more complex item types may flag two important points for the unwary test developer: the quality of published items may be insufficient to allow their inclusion in high-quality tests, and furthermore, the production of reliable multiple-choice items is a difficult skill to learn. In addition it may not be appropriate to attempt to stretch multiple-choice items by using options such as ‘all’ or ‘none of the above’. The evidence from this test seems to suggest that multiple-choice items may not be appropriate to test outcomes at undergraduate level

A narrative literature review of games, animations and simulations to teach research methods and statistics

Basic competence in research methods and statistics is core for many undergraduates but many students experience difficulties in acquiring knowledge and skills in this area. Interest has recently turned to serious games as providing engaging ways of learning. The CHERMUG project was developed against this background to develop games to support students in learning about research methods and statistics. As a first step in designing the CHERMUG games a narrative literature review was carried out to establish whether similar games, animations and simulations already existed. Search terms used in the literature review included varied terms for digital games, simulations and animations, terms relevant to the twin goals of learning and engagement in games and terms for research methods and statistics. Application of the inclusion criteria led to 26 papers which were considered relevant. Synthesis of the papers suggested that there is reason to be optimistic that a game-based approach might be effective in learning in this area.This research was supported by a grant from the European Community under the Lifelong Learning Programme project nr. 519023-LLP-1- 2011-1-UK-KA3-KA3MP

Promoting students’ safety and wellbeing : Ethical practice in schools

Although ‘child safety’ is now a national policy priority in Australia, there is little research exploring the practices in schools that contribute to children and young people’s felt sense of safety and wellbeing. Drawing on a mixed-method Australian Research Council (ARC) Discovery project, this article presents findings from interviews with school staff (N = 10), leaders (N = 5) and nine focus groups with students (N = 58), in primary and secondary schools in three Australian states (New South Wales, Victoria and South Australia). We employ relational ethics, recognition theory and the theory of practice architectures to explore practices at school that support student wellbeing and safety. The findings contribute significantly to understanding the ‘bundled’ nature of current practices and the conditions that enable and constrain these. Close attention to these findings is critical as schools seek to operationalise the National Child Safe Principles and refine ongoing safeguarding procedures. The findings have informed the development of an online survey that is currently testing, on a much larger scale, which elements of ethical practice are most positively associated with students’ safety, wellbeing and recognition at school

Immune-engineered H7N9 Influenza Hemagglutinin Improves Protection against Viral Influenza Virus Challenge

The influenza hemagglutinin (HA) isolated from avian H7N9 influenza virus strains elicit weak immune responses. This low immunogenicity may be due to a regulatory T cell (Treg)–stimulating epitopes in HA from the H7N9 isolate A/Anhui/1/2013 (Anh/13). In this report, this Treg stimulating sequence was removed from the wild-type (WT) H7 HA amino acid sequence and replaced with a conserved CD4 + T cell stimulating sequences from human seasonal H3N2 strains and designed OPT1 H7 HA. The effectiveness of this optimized H7 HA protein was determined using a humanized mouse (HLA-DR3) expressing the human leukocyte antigen (HLA) DR3 allele. HLA-DR3 mice were pre-immunized by infecting with H3N2 influenza virus, A/Hong Kong/4108/2014 and then vaccinated intramuscularly with either the WT H7 HA from Anh/13 or the OPT1 H7 HA antigen without adjuvant. The OPT1 H7 HA vaccination group elicited higher H7 HA-specific IgG titers that resulted in a lower mortality, weight loss, and lung viral titer following lethal challenge with the H7N9 Anh/13 influenza virus compared to WT-vaccinated mice. Overall, T-cell epitope-engineered vaccines can improve the immunogenicity of H7 HA antigens resulting in enhanced survival and lower morbidity against H7N9 influenza virus challenge

Newborn screening for cystic fibrosis: evaluation of benefits and risks and recommendations for state newborn screening programs

In November 2003, CDC and the Cystic Fibrosis Foundation cosponsored a workshop to review the benefits and risks associated with newborn screening for cystic fibrosis (CF). This report describes new research findings and outlines the recommendations of the workshop. The peer-reviewed evidence presented at the workshop supports the clinical utility of newborn screening for CF. Demonstrated long-term benefits from early nutritional treatment as a result of newborn screening for CF include improved growth and, in one study, cognitive development. Other benefits might include reduced hospitalizations and improved survival. Mixed evidence has been reported for pulmonary outcomes. Newborn screening in the United States is associated with diagnosis of CF a median of 1 year earlier than symptomatic detection, which might reduce the expense and anxiety associated with workup for failure to thrive or other symptoms. Certain psychosocial risks for carrier children and their families (e.g., anxiety and misunderstanding) are associated with newborn screening. Exposure of young children to infectious agents through person-to-person transmission in clinical settings, although not an inherent risk of newborn screening, is a potential cause of harm from early detection. Involving specialists in CF care and infection control, genetic counseling, and communication can minimize these potential harms. Although screening decisions depend on a state\u27s individual resources and priorities, on the basis of evidence of moderate benefits and low risk of harm, CDC believes that newborn screening for CF is justified. States should consider the magnitude of benefits and costs and the need to minimize risks through careful planning and implementation, including ongoing collection and evaluation of outcome data

Universal H1N1 influenza vaccine development

Immune responses to cross-conserved T cell epitopes in novel H1N1 influenza may explain reports of diminished influenza-like illnesses and confirmed infection among older adults, in the absence of cross-reactive humoral immunity, during the 2009 pandemic. These cross-conserved epitopes may prove useful for the development of a universal H1N1 influenza vaccine, therefore, we set out to identify and characterize cross-conserved H1N1 T cell epitopes. An immunoinformatic analysis was conducted using all available pandemic and pre-pandemic HA-H1 and NA-N1 sequences dating back to 1980. Using an approach that balances potential for immunogenicity with conservation, we derived 13 HA and four NA immunogenic consensus sequences (ICS) from a comprehensive analysis of 5 738 HA-H1 and 5 396 NA-N1 sequences. These epitopes were selected because their combined epitope content is representative of greater than 84% of pre-pandemic and pandemic H1N1 influenza strains, their predicted immunogenicity (EpiMatrix) scores were greater than or equal to the 95th percentile of all comparable epitopes, and they were also predicted to be presented by more than four HLA class II archetypal alleles. We confirmed the ability of these peptides to bind in HLA binding assays and to stimulate interferon-γ production in human peripheral blood mononuclear cell cultures. These studies support the selection of the ICS as components of potential group-common H1N1 vaccine candidates and the application of this universal influenza vaccine development approach to other influenza subtypes

Therapeutic administration of Tregitope-Human Albumin Fusion with Insulin Peptides to promote Antigen-Specific Adaptive Tolerance Induction.

Type 1 Diabetes (T1D) is an autoimmune disease that is associated with effector T cell (Teff) destruction of insulin-producing pancreatic beta-islet cells. Among the therapies being evaluated for T1D is the restoration of regulatory T cell (Treg) activity, specifically directed toward down-modulation of beta-islet antigen-specific T effector cells. This is also known as antigen-specific adaptive tolerance induction for T1D (T1D ASATI). Tregitopes (T regulatory cell epitopes) are natural T cell epitopes derived from immunoglobulin G (IgG) that were identified in 2008 and have been evaluated in several autoimmune disease models. In the T1D ASATI studies presented here, Tregitope peptides were administered to non-obese diabetic (NOD) mice at the onset of diabetes within two clinically-relevant delivery systems (liposomes and in human serum albumin [HSA]-fusion products) in combination with preproinsulin (PPI) target antigen peptides. The combination of Tregitope-albumin fusions and PPI peptides reduced the incidence of severe diabetes and reversed mild diabetes, over 49 days of treatment and observation. Combining HSA-Tregitope fusions with PPI peptides is a promising ASATI approach for therapy of T1D