Workshop to identify critical windows of exposure for children's health: cancer work group summary.

We considered whether there are discrete windows of vulnerability in the development of cancer and which time periods may be of the greatest importance. Cancer was considered broadly, including cancers in childhood as well as adult cancers that may have an in utero or childhood origin. We concluded that there was evidence from animal and epidemiologic studies for causal relationships for preconceptional, in utero, and childhood exposures and cancer occurrence in children and adults. However, the evidence is incomplete and all relevant critical windows may not have been identified. The comprehensive evaluation of the relative importance of specific time windows of exposure is limited. Improvements in the design of epidemiologic studies and additional animal studies of mechanisms are warranted

Upper Limb Function in People With Upper and Lower Limb Loss 8 Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study

Upper limb (UL) disability in people with UL amputation/s is well reported in the literature, less so for people with lower limb amputation/s. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb amputation/s.A volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann–Whitney U and Kruskal Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.DASH scores were higher in the group with injuries compared to the group without injuries (3.33 vs 0.00) and higher in people with lower limb loss compared to the group without injuries (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18–2.47) times higher for people with lower limb loss compared to the group without injuries. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07–13.60) times higher for people with UL loss compared to the uninjured group.People with lower limb loss have increased odds of having more UL disability than the uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years.For the first time, potential for greater upper limb disability has been shown in people with lower limb loss long-term, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique

Exploring solar-terrestrial interactions via multiple imaging observers

How does solar wind energy flow through the Earth's magnetosphere, how is it converted and distributed? is the question we want to address. We need to understand how geomagnetic storms and substorms start and grow, not just as a matter of scientific curiosity, but to address a clear and pressing practical problem: space weather, which can influence the performance and reliability of our technological systems, in space and on the ground, and can endanger human life and health. Much knowledge has already been acquired over the past decades, particularly by making use of multiple spacecraft measuring conditions in situ, but the infant stage of space weather forecasting demonstrates that we still have a vast amount of learning to do. A novel global approach is now being taken by a number of space imaging missions which are under development and the first tantalising results of their exploration will be available in the next decade. In this White Paper, submitted to ESA in response to the Voyage 2050 Call, we propose the next step in the quest for a complete understanding of how the Sun controls the Earth's plasma environment: a tomographic imaging approach comprising two spacecraft in highly inclined polar orbits, enabling global imaging of magnetopause and cusps in soft X-rays, of auroral regions in FUV, of plasmasphere and ring current in EUV and ENA (Energetic Neutral Atoms), alongside in situ measurements. Such a mission, encompassing the variety of physical processes determining the conditions of geospace, will be crucial on the way to achieving scientific closure on the question of solar-terrestrial interactions.Peer reviewe

Exploring Solar-Terrestrial Interactions via Multiple Observers (A White Paper for the Voyage 2050 long-term plan in the ESA Science Programme)

This paper addresses the fundamental science question: "How does solar wind energy flow through the Earth's magnetosphere, how is it converted and distributed?". We need to understand how the Sun creates the heliosphere, and how the planets interact with the solar wind and its magnetic field, not just as a matter of scientific curiosity, but to address a clear and pressing practical problem: space weather, which can influence the performance and reliability of our technological systems, in space and on the ground, and can endanger human life and health. Much knowledge has already been acquired over the past decades, but the infant stage of space weather forecasting demonstrates that we still have a vast amount of learning to do. We can tackle this issue in two ways: 1) By using multiple spacecraft measuring conditions in situ in the magnetosphere in order to make sense of the fundamental small scale processes that enable transport and coupling, or 2) By taking a global approach to observations of the conditions that prevail throughout geospace in order to quantify the global effects of external drivers. A global approach is now being taken by a number of space missions under development and the first tantalising results of their exploration will be available in the next decade. Here we propose the next step-up in the quest for a complete understanding of how the Sun gives rise to and controls the Earth's plasma environment: a tomographic imaging approach comprising two spacecraft which enable global imaging of magnetopause and cusps, auroral regions, plasmasphere and ring current, alongside in situ measurements. Such a mission is going to be crucial on the way to achieve scientific closure on the question of solar-terrestrial interactions

Boundary spanning as identity work in university business engagement roles

The study explores how boundary-spanning is carried out to further community engagement in 15 universities of differing sizes/ages across the United Kingdom. Fifteen interviewees participated in a series of four semi-structured interviews, aged between 35–50 and with a first degree (with almost half with an MSc). One third were women. All managed their own teams and felt these were their base in negotiating difficult internal territory.. Here, boundary spanning is found to be synonymous with identity work, carried out to enable individuals to adapt to different internal and external conditions and requirements through processes of interaction and learning. It also suggests the strategic construction of identities to address perceived threats and insecurities - and the impacts of change, dominant organisational discourse and senior management on this process. Their job titles were not useful as identity badges to signal meaning, due to these being outside ‘what universities are for’

Interpretative Phenomenological Analysis of Soldiers’ Experiences of Being Married and Serving in the British Army

© 2016, Copyright © Taylor & Francis Group, LLC. ABSTRACT: Research suggests certain aspects of military life, especially operational deployments, may negatively impact military marriages. However, much of this research is from the United States and uses deductive quantitative methods. Qualitative research investigating the lived experiences of forming and maintaining marriages was conducted with six male U.K. Army personnel. Semistructured interviews were analyzed, using Interpretative Phenomenological Analysis, identifying five themes, each representing different dilemmas the soldiers’ had to balance to maintain successful marriages and Army careers. These five themes are best understood as practical, emotional, and cultural dilemmas that can be alleviated with practical and emotional methods; such factors could be used to build resilience in soldier’s marriages. These possible resilience factors could shape the content of interventions to increase resiliency in military marriages

An infectious aetiology for childhood brain tumours? Evidence from space–time clustering and seasonality analyses

To investigate whether infections or other environmental exposures may be involved in the aetiology of childhood central nervous system tumours, we have analysed for space–time clustering and seasonality using population-based data from the North West of England for the period 1954 to 1998. Knox tests for space–time interactions between cases were applied with fixed thresholds of close in space, <5 km, and close in time, <1 year apart. Addresses at birth and diagnosis were used. Tests were repeated replacing geographical distance with distance to the Nth nearest neighbour. N was chosen such that the mean distance was 5 km. Data were also examined by a second order procedure based on K-functions. Tests for heterogeneity and Edwards' test for sinusoidal variation were applied to examine changes of incidence with month of birth or diagnosis. There was strong evidence of space–time clustering, particularly involving cases of astrocytoma and ependymoma. Analyses of seasonal variation showed excesses of cases born in the late Autumn or Winter. Results are consistent with a role for infections in a proportion of cases from these diagnostic groups. Further studies are needed to identify putative infectious agents

Quality of life and functionality after total hip arthroplasty: a long-term follow-up study

<p>Abstract</p> <p>Background</p> <p>There is a lack of data on the long-term outcome of total hip arthroplasty procedures, as assessed by validated tools.</p> <p>Methods</p> <p>We conducted a follow-up study to evaluate the quality of life and functionality of 250 patients an average of 16 years (range: 11-23 years) after total hip arthroplasty using a validated assessment set including the SF-36 questionnaire, Harris Hip Score, WOMAC score, Functional Comorbidity Index, and a study specific questionnaire. Models of multiple stepwise linear and logistic regression analysis were constructed to evaluate the relationships between several explanatory variables and these functional outcomes.</p> <p>Results</p> <p>The SF-36 physical indexes of these patients compared negatively with the normative values but positively with the results obtained in untreated subjects with severe hip osteoarthritis. Similar results were detected for the Harris Hip Score and WOMAC score. There was a 96% rate of post-surgical satisfaction. Hip functionality and comorbidities were the most important determinants of physical measures on the SF-36.</p> <p>Conclusions</p> <p>Patients who had undergone total hip arthroplasty have impaired long-term self-reported physical quality of life and hip functionality but they still perform physically better than untreated patients with advanced hip osteoarthritis. However, the level of post-surgical satisfaction is high.</p

Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review

BACKGROUND: For decades, there is an unresolved debate about adequate prescription of antibiotics for patients suffering from exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to analyse randomised controlled trials investigating the clinical benefit of antibiotics for COPD exacerbations. METHODS: We conducted a systematic review of randomised, placebo-controlled trials assessing the effects of antibiotics on clinically relevant outcomes in patients with an exacerbation. We searched bibliographic databases, scrutinized reference lists and conference proceedings and asked the pharmaceutical industry for unpublished data. We used fixed-effects models to pool results. The primary outcome was treatment failure of COPD exacerbation treatment. RESULTS: We included 13 trials (1557 patients) of moderate to good quality. For the effects of antibiotics on treatment failure there was much heterogeneity across all trials (I(2 )= 82%). Meta-regression revealed severity of exacerbation as significant explanation for this heterogeneity (p = 0.016): Antibiotics did not reduce treatment failures in outpatients with mild to moderate exacerbations (pooled odds ratio 1.09, 95% CI 0.75–1.59, I(2 )= 18%). Inpatients with severe exacerbations had a substantial benefit on treatment failure rates (pooled odds ratio of 0.25, 95% CI 0.16–0.39, I(2 )= 0%; number-needed to treat of 4, 95% CI 3–5) and on mortality (pooled odds ratio of 0.20, 95% CI 0.06–0.62, I(2 )= 0%; number-needed to treat of 14, 95% CI 12–30). CONCLUSION: Antibiotics effectively reduce treatment failure and mortality rates in COPD patients with severe exacerbations. For patients with mild to moderate exacerbations, antibiotics may not be generally indicated and further research is needed to guide antibiotic prescription in these patients

Validation of a screening questionnaire for hip and knee osteoarthritis in old people

<p>Abstract</p> <p>Background</p> <p>To develop a sensitive and specific screening tool for knee and hip osteoarthritis in the general population of elderly people.</p> <p>Methods</p> <p>The Knee and Hip OsteoArthritis Screening Questionnaire (KHOA-SQ) was developed based on previous studies and observed data and sent to 11,002 people aged 60 to 90 years, stratified by age and gender, who were selected by random sampling. Algorithms of the KHOA-SQ were created. Respondents positive for knee or hip OA on the KHOA-SQ were invited to be evaluated by an orthopedic surgeon. A sample of 300 individuals negative for knee or hip OA on the KHOA-SQ were also invited for evaluation. Sensitivity and specificity were determined for the KHOA-SQ, as well as for KHOA-SQ questions. Classification and Regression Tree analysis was used to find alternative screening algorithms from the questionnaire.</p> <p>Results</p> <p>Of 11,002 individuals contacted, 7,577 completed the KHOA-SQ. Of 1,115 positive for knee OA, on the KHOA-SQ, 710 (63.6%) were diagnosed with it. For hip OA, 339 of the 772 who screened positive (43.9%) were diagnosed it. Sensitivity for the hip algorithm was 87.4% and specificity 59.8%; for the knee, sensitivity was 94.5% and specificity 43.8%. Two alternative algorithms provided lower specificity.</p> <p>Conclusion</p> <p>The KHOA-SQ offers high sensitivity and moderate specificity. Although this tool correctly identifies individuals with knee or hip OA, the high false positive rate could pose problems. Based on our questions, no better algorithm was found.</p