The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC): International consensus statement and user guide

Effective physical activity messaging plays an important role in the pathway towards changing physical activity behaviour at a population level. The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC) are outputs from a recent modified Delphi study. This sought consensus from an international expert panel on how to aid the creation and evaluation of physical activity messages. In this paper, we (1) present an overview of the various concepts within the PAMF and PAMC, (2) discuss in detail how the PAMF and PAMC can be used to create physical activity messages, plan evaluation of messages, and aid understanding and categorisation of existing messages, and (3) highlight areas for future development and research. If adopted, we propose that the PAMF and PAMC could improve physical activity messaging practice by encouraging evidence-based and target population focused messages with clearly stated aims and consideration of potential working pathways. They could also enhance the physical activity messaging research base by harmonising key messaging terminologies, improving quality of reporting, and aiding collation and synthesis of the evidence

Hyperinsulinaemic hypoglycaemia: A rare association of vanishing white matter disease.

We report two unrelated patients with infantile onset leukoencephalopathy with vanishing white matter (VWM) and hyperinsulinaemic hypoglycaemia. To our knowledge, this association has not been described previously. Both patients had compound heterozygous pathogenic variants in EIF2B4 detected on exome sequencing and absence of other variants which might explain the hyperinsulinism. Hypoglycaemia became apparent at 6 and 8 months, respectively, although in one patient, transient neonatal hypoglycaemia was also documented. One patient responded to diazoxide and the other was managed with continuous nasogastric feeding. We hypothesise that the pathophysiology of hyperinsulinism in VWM may involve dysregulation of transcription of genes related to insulin secretion

Hexose synthesis by cell wall invertase activity and its effects on the roasting behaviour of macadamia kernel

After roast darkening (ARD) is a defect concealed in the raw macadamia kernel, only becoming evident upon roasting. Kernels susceptible to some forms of ARD reportedly have a higher glucose and fructose concentration. By developing a procedure to simulate ARD and through the inclusion of effector molecules we have demonstrated that the enzyme invertase is key to this form of ARD. Biochemical analysis of raw mature kernel has shown high invertase activity. Separating the extract into pellet and soluble fractions showed that the high invertase activity occurred in the pellet fraction containing the cell wall isoform and that the soluble fraction had little activity. A broad peak in crude cell wall invertase activity occurred between pH 3.75 and 5.0. Enzyme kinetics of the cell wall invertase from crude extracts assayed at pH 4 indicated a high level of activity (V = 4.11 ± 0.55 mg glucose produced/g fresh weight tissue.h), a high affinity for sucrose (K = 2.02 ± 0.96 mM), and inhibition by MgCl (K = 71.2 ± 12.5 mM). We propose that the initial step in the processes leading to ARD in macadamia could involve membrane damage and subsequent modification of the kernel sugar composition by cell wall invertase

Risk factors for urinary catheter associated bloodstream infection

Objectives: Urinary catheter associated bloodstream infection (UCABSI) causes significant morbidity, mortality and healthcare costs. We aimed to define the risk factors for UCABSI. Methods: A case-control study was conducted at two Australian tertiary hospitals. Patients with urinary source bloodstream infection associated with an indwelling urinary catheter (IDC) were compared to controls with an IDC who did not develop urinary source bloodstream infection. Results: There were 491 controls and 67 cases included in the analysis. Independent statistically significant risk factors for the development of UCABSI included insertion of the catheter in operating theatre, chronic kidney disease, age-adjusted Charlson comorbidity index, accurate urinary measurements as reason for IDC insertion and dementia. IDCs were inserted for valid reasons in nearly all patients, however an appropriate indication at 48hpost-insertion was found in only 44% of patients. Initial empiric antibiotics were deemed inappropriate in 23 patients (34%). Conclusion: To our knowledge, this is the first study to look specifically at the risk factors for bloodstream infection in urinary catheterised patients. Several risk factors were identified. IDC management and empiric management of UCABSI could be improved and is likely to result in a decreased incidence of infection and its complications

Even high-dose extended infusions may not yield desired concentrations of beta-lactams: the value of therapeutic drug monitoring

A 35-year-old patient in intensive care with severe burn injury developed episodes of sepsis. Blood culture yielded a multidrug-resistant Pseudomonas aeruginosa and treatment was commenced with amikacin (minimum inhibitory concentration (MIC) 2-4 mg/L, dose 20 mg/kg adjusted body weight 24-hourly) and meropenem (MIC 8 mg/L, dose 2 g IV 8-hourly and later 6-hourly). Despite the use of extended infusions with beta-lactam therapeutic drug monitoring and doses that were more than 2.5 times higher than standard meropenem doses, resistance emerged. This case report describes the application of therapeutic drug monitoring to optimize beta-lactam therapy in a difficult-to-treat critically ill patient