Outcomes of Treated Human Granulocytic Ehrlichiosis Cases

We conducted a case-control study in Wisconsin to determine whether some patients have long-term adverse health outcomes after antibiotic treatment for human granulocytic ehrlichiosis (HGE). A standardized health status questionnaire was administered to patients and controls matched by age group and sex. Consenting patients provided blood samples for serologic testing. Among the 85 previously treated patients, the median interval since onset of illness was 24 months. Compared with 102 controls, patients were more likely to report recurrent or continuous fevers, chills, fatigue, and sweats. Patients had lower health status scores than controls for bodily pain and health relative to 1 year earlier, but there was no significant difference in physical functioning, role limitations, general health, or vitality measures. The HGE antibody titer remained elevated in one patient; two had elevated aspartate aminotransferase levels. HGE may cause a postinfectious syndrome characterized by constitutional symptoms without functional disability or serologic evidence of persistent infection

Cognitive function in childhood and lifetime cognitive change in relation to mental wellbeing in four cohorts of older people

Background: poorer cognitive ability in youth is a risk factor for later mental health problems but it is largely unknown whether cognitive ability, in youth or in later life, is predictive of mental wellbeing. The purpose of this study was to investigate whether cognitive ability at age 11 years, cognitive ability in later life, or lifetime cognitive change are associated with mental wellbeing in older people.Methods: we used data on 8191 men and women aged 50 to 87 years from four cohorts in the HALCyon collaborative research programme into healthy ageing: the Aberdeen Birth Cohort 1936, the Lothian Birth Cohort 1921, the National Child Development Survey, and the MRC National Survey for Health and Development. We used linear regression to examine associations between cognitive ability at age 11, cognitive ability in later life, and lifetime change in cognitive ability and mean score on the Warwick Edinburgh Mental Wellbeing Scale and meta-analysis to obtain an overall estimate of the effect of each.Results: people whose cognitive ability at age 11 was a standard deviation above the mean scored 0.53 points higher on the mental wellbeing scale (95% confidence interval 0.36, 0.71). The equivalent value for cognitive ability in later life was 0.89 points (0.72, 1.07). A standard deviation improvement in cognitive ability in later life relative to childhood ability was associated with 0.66 points (0.39, 0.93) advantage in wellbeing score. These effect sizes equate to around 0.1 of a standard deviation in mental wellbeing score. Adjustment for potential confounding and mediating variables, primarily the personality trait neuroticism, substantially attenuated these associations.Conclusion: associations between cognitive ability in childhood or lifetime cognitive change and mental wellbeing in older people are slight and may be confounded by personality trait difference

Evolution challenges. Integrating research and practice in teaching and learning about evolution

Abstract and Keywords Scientists frequently attribute public misunderstanding of evolution to religious or political influences. Ineffective undergraduate teaching has also contributed. Faculty often ignored strong pedagogical evidence. Five research conclusions are discussed: The traditional lecture approach is inadequate. Active learning is much more effective. Fundamental reasoning difficulties limit students' understanding. Simple steps help overcome these. Misconceptions typically persist unless directly addressed with a conceptual-change approach. Evolution is a complex set of ideas that cannot be adequately understood without advanced critical thinking. This is infrequently mastered without intentionally designed learning tasks. Understanding evolution is typically insufficient for its acceptance. But acceptance as valid for real-world decisions is important. This requires helping students consider social and affective factors related to evolution. Keywords: misconceptions, conceptual-change, intentional design, evolution acceptance Scientists frequently attribute the public misunderstanding of evolution largely to conservative religious influences or dubious political motivations. Indeed, Mazur (2004 found Christian religiosity to be the strongest correlate of "disbelief" in evolution with low educational attainment and political conservatism also important. How science is taught in undergraduate education is a powerful additional factor that usually has been ignored in analyses of Why Don't Undergraduates Really "Get" Evolution? What Can ... http://www.oxfordscholarship.com.ezproxy.lib.indiana.edu/vie... of 27 6/25/13 5:37 PM public misunderstanding of evolution. Rejection and misunderstanding of evolution are not simply the results of some facets of American culture. Rather, they are also the predictable results of traditional, didactic teaching strategies. Postsecondary science teaching often ignores strong evidence on ways to make instruction much more effective (e.g., The first part of this chapter focuses on four broadly applicable results of research on teaching undergraduate science. The latter part turns to strategies that take account of factors that apply more strongly to evolution than to much of the rest of science. Key Result 1: Active Learning Is More Effective Active learning substantially increases achievement when compared with traditional pedagogy in undergraduate science, a conclusion featured in a review in Science The inadequacy of the traditional lecture approach in undergraduate science has been demonstrated most extensively in physics, where active methods roughly doubled average normalized pretest to posttest gains in learning, an effect approximating a two standard deviation difference Thus, one answer to the question "What can faculty do to increase the proportion of students who 'get' evolution?" is to switch further toward structured active learning in lieu of more didactic pedagogies. The implications of this conclusion can be both distressing and elating. This conclusion can be distressing because time already spent on improving lectures would often have been spent much more effectively on improving pedagogy. The conclusion can be elating because changes can be fairly easy and can have large effects. Unfortunately, faculty often have reservations about adopting active learning. These reservations include loss of content coverage, possible loss of control over the class, and possible failure of the activities. Tanner (2009) addressed a number of these. Similarly, several dysfunctional illusions that falsely suggest a lack of rigor for more effective pedagogies probably have slowed their adoption However one chooses to label these reasoning abilities, scores on reasoning tests have often been shown to predict achievement in undergraduate science courses and, sometimes, in precollege science (e.g., These findings have profound implications for understanding and teaching molecular aspects of biology generally, and of evolution specifically, as shown by studies of undergraduate chemistry. For example, Herron (1975) listed startling differences between core ideas in chemistry that the concrete students can and cannot understand without altered pedagogy. These students will be a large fraction of any first-year class. (p.314) Scores on reasoning tests were also related to the acceptance of evolution. Students who scored lower on tests of basic reasoning were less likely to accept evolution on the pretest and were more likely to continue to reject evolution on the posttest than individuals who performed better on the reasoning assessment A major advance for understanding how differences in reasoning play out in learning biology was recently provided by 1. Descriptive predictions could be mastered by most students whatever their scores on reasoning tests. 2. Tasks requiring understanding and testing hypotheses involving perceptible causal agents (e.g., light, moisture) were usually mastered only by students with higher reasoning scores. 3. Tasks using hypotheses involving causal agents that cannot be as directly perceived (e.g., genetic versus environmental causation, chemical communication) were usually mastered only by students with even higher reasoning abilities. Much greater pedagogical support is needed for tasks requiring the use of causal hypotheses, especially those using inferred causal agents. These distinctions are fundamental to students' difficulties in understanding evolution and to the development of effective ways to help them master it. Unfortunately, the underlying reasoning patterns are not changed easily with conventional teaching. Other researchers have made additional suggestions for fostering more complex reasoning. For example, a nice example of the use of hands-on modeling to support more complex thinking in a large molecular biology class was provided by In summary, the answer to the question "What can faculty do to increase the proportion of students who 'get' evolution?" from this second perspective is that faculty often need to pay more attention to students' basic reasoning and to teach in ways that better support (rather than just require) scientific understanding and reasoning. Without such support many students cannot understand what is being taught even when they are trying quite hard to do so. Although these problems and many of the solutions have been clear for decades, they have not been widely adopted. "Because we [as faculty] are at the point that concrete experience … is superfluous, we tend to forget that it was not always so [for us] and in our rush to 'cover the material,' we omit the very kind of experiences that can make our subject meaningful to beginning students" (Herron, 1978, p. 167). Many faculty will be skeptical (as I was) that well-performing students are deficient in understanding the basic concepts that should underlie their successes in class. It may be hard to accept that even "facility in solving standard quantitative problems is not an adequate criterion for functional understanding" (Thornton, 1999). In order to see the limitations of current approaches and the effects of changes we need more sophisticated ways of writing in-class and exam assessments About the Index Search across all sources Show related links Why Don't Undergraduates Really "Get" Evolution? What Can ... http://www.oxfordscholarship.com.ezproxy.lib.indiana.edu/vie... of 27 6/25/13 5:37 PM macroevolution is central to an understanding of the strength of the evidence showing that evolution has occurred (Padian, 2010). Further, macroevolution "is perhaps the primary stumbling block" for students, teachers, and other adults who have difficulty accepting evolution (M. U. Smith, 2010b, p. 541). The switch in students' understanding from misconceptions or alternative conceptions to scientifically valid views is termed conceptual change (for evolution: Banet & Ayuso, 2003; Various approaches to teaching evolution have attempted to produce major conceptual change and understanding generally. M. U. Smith (2010b) provided a concise (p.317) overview. Six examples merit special discussion. Although these mostly address microevolution, they could be modified for topics in macroevolution. 1. An Exemplary Conceptual Change Approach. Banet and Ayuso About the Index Search across all sources Show related links Why Don't Undergraduates Really "Get" Evolution? What Can ... http://www.oxfordscholarship.com.ezproxy.lib.indiana.edu/vie... of 27 6/25/13 5:37 PM Roscoe, this volume). 5. Participatory Action Research. In a multiyear study, Grant (2008) examined the misconceptions his first-year biology students held about natural selection. "Many students who presented evidence on pre-tests that they harbored substantial misconceptions in fact remained highly resistant to instruction, and often defended their misconceptions using course appropriate terminology, but incorrectly, on the course final exam. In other words, many had hijacked course content in service of their misconceptions" (Grant, 2008, p. 15). He iteratively designed ways to address these in a large class setting. Key changes included repeatedly presenting summaries of in-class surveys of prior knowledge and misconceptions. He also asked students to discuss with their neighbors what evidence and arguments would be needed to foster the replacement of these misconceptions with expert knowledge. He termed this "participatory action research." It required substantial reductions in content and rearrangements of topics. There were large increases over previous years in the grades on the final examination questions on evolution: On a key question assessing natural selection, good answers (8 to10 of 10 points) increased from about 3% of students (2000)(2001)(2002)(2003)(2004)(2005) to 54% (2006)(2007), and very low scores (0-2 points) were eliminated. This approach has considerable promise for improving undergraduate science learning generally. Whole Course Transformation. In what is essentially a deep conceptual change approach, BioQUEST has emphasized computer-facilitated, case-based learning with a focus on problem-posing, problem-solving, and peer persuasion, often addressing topics in evolution In summary, the answer to the question "What can faculty do to increase the proportion of students who 'get' evolution?" from this third perspective is that faculty often need to give even more attention to students' persistent misunderstandings and to teach in ways that better support conceptual change (rather than falsely assuming that telling students the right idea or showing them the data will be sufficient to elicit change). Without explicit, active support for conceptual change, most students will retain their initial misunderstandings. (p.319) Key Result 4: Complex Thinking Is Requisite for Understanding Evolution Many of the difficulties we encounter in getting students to understand evolution are well explained by differences in their approaches to knowledge, specifically to how they expect to understand new topics. These approaches range from "just tell me what to memorize" to expecting us to help them understand the applications, implications, and trade-offs in various contexts. These different approaches are usefully understood as differences in adult cognitive development. There is a substantial body of research on cognitive development in college and its implications for learning and teaching. This approach began with Perry's (1970) study of "intellectual and ethical development" in undergraduates. Perry's work has been cited by hundreds of subsequent studies (partially reviewed by Cognitive development beyond that typically found in undergraduates is a prerequisite for an adequate understanding of evolution. Sinatra, Southerland, McConaughy, and Demastes About the Index Search across all sources Show related links Why Don't Undergraduates Really "Get" Evolution? What Can ... http://www.oxfordscholarship.com.ezproxy.lib.indiana.edu/vie... 6 of 27 6/25/13 5:37 PM they termed absolutism, relativism, and evaluativism. Perry's terms for these three approaches (dualism, multiplicity, and relativism) have been widely used, although some studies have used alternative terminologies. A simplified summary of these major cognitive differences will make clearer the implications for teaching evolution. (p.320) Absolutism (Perry's Dualism) About two-thirds of first-year students and half of sophomores had absolutism as their core approach Relativism (Perry's Multiplicity) When students first encounter meaningful uncertainty in a new area they typically have no idea how it might be resolved. In the face of uncertainty all opinions seem to be equally valid-any answer that one prefers on whatever grounds is fine. Personal experience, personally interpreted, has the preeminent role. This is the approach most of us usually use in picking a flavor of ice cream, but it is a terrible approach to critical thinking About one-third of first-year students and perhaps 80% of seniors were "transitional": they regarded knowledge in some areas as absolute and knowledge in others as uncertain and, hence, arbitrary Burgoyne and Downey (2011) have suggested that we ask students to see absolutism and relativism as two misconceptions: Contextual Knowing (Bendixen and Rule's Evaluativism; Perry's Relativism) The approach where students have learned to make context-framed, criteria-based comparisons has also been termed contextual relativism (e.g., Knefelkamp, 1999) (p.321) and contextual knowing As students become more cognitively sophisticated, they (like many older adults) typically use a mosaic of approaches, perhaps treating some topics in dualism/absolutism and some in multiplicity even while struggling to master contextual knowing in others Beyond Contextual Knowing The limitations of simple contextual knowing are evident when we consider complex problems. The core difficulty is that students who have learned to operate within a series of individual disciplines often have no coherent way to deal with differences that arise when a variety of disciplines apply to a complex problem. They consequently see any choice among combinations of disciplinary For example, even a local environmental issue, such as the appropriateness of a nuclear power plant, requires a consideration of trade-offs across multiple perspectives including science, waste disposal, environmental economics, politics, and environmental racism, to name just a few To deal with such issues constructively, students must learn to consider the benefits and negative consequences illuminated by each perspective. As students learn to make such analyses they begin thinking in a way that Perry termed "Commitment [within contextual relativism]" and Baxter Magolda termed "self-authorship." This approach is exceedingly rare among undergraduates except under transformed curricula Applications to Teaching Evolution "Perhaps the most useful developmental theory to be applied to evolution instruction is that of Perry" (M. U. Smith, 2010b, p. 541; also Nelson, 1986, etc.). Classroom applications that strive to foster cognitive development can profitably focus on key aspects of the three transitions between the four main approaches to understanding. (p.322) These are: initially understanding uncertainty, then using comparisons and criteria to address uncertainty (contextual knowing) and, later, using consequences and values to frame arguments and justify choices. Uncertainty in evolution can be invoked, for example, by listing (or having the class list) currently viable alternative hypotheses, listing ones that were historically viable or by asking for deep understanding of experimental designs (Why is this control included? Are any controls missing? What untested hypotheses might have produced the same results?). Once some important uncertainty has been made clear, the alternative hypotheses or design considerations or other factors need to be compared, and possibly resolved, using appropriate criteria. Unless both the alternatives and the criteria are made explicit, most of the critical thinking will be tacit and therefore incomprehensible-and the students' approaches to thinking will be unaffected. For comparisons of historically grounded alternatives in evolution, such as what sequences should have been expected from the fossil record, an appropriate criterion is the result of a fair test. A fair test is a new set of data that could have confirmed any of the alternatives and that is different from (and not tightly tied to) the data sets on which they were proposed. We can ask: What patterns of change in the fossil record might have been expected of the fossil record when the geological column was first put into its modern order in the 1840s, noting that evolution was not really available except to Darwin. Alternatives included: all kinds at the beginning with just extinction, Lyell's large cycles with great reptiles perhaps returning again (and again), Sedgwick's extinctions and new recreations, vertebrates first and invertebrates by degeneration, and, of course, evolution starting, as Darwin noted, with one or a few very simple kinds. Students will suggest some of these ideas, if asked. The fossil record itself provides a fair test of these alternatives, as most of them were not based on the ordered sequence of rocks in the newly emerging geological column and as any of the alternative patterns could have been found. A number of other criteria are also important. These include accounting for apparently conflicting scientific data and the availability of causal explanations (e.g., However, even when we understand that one alternative is much more probable than another we may choose not to accept it. It is often appropriate to reject hypotheses that are probably true when there are serious risks to accepting the hypothesis and being wrong. Thus, for many considerations of safety in the face of severe consequences we demand not just that safety be very probable but that it be overwhelmingly probable (basic decision theory, below). This requires moving beyond contextual knowing. For students studying evolution, going beyond contextual knowing would require that students understand the force of the evidence in the context of the nature of science generally; understand and know how to weigh the consequences (p.323) from the applications of evolution, both positive and negative; and understand how to fit evolution into larger cultural contexts. It thus becomes crucial for faculty members who teach evolution to help students address its consequences and applications. Faculty also need to consider whether to address the cultural contexts for evolution and, if so, how to do so effectively. About the Index Search across all sources Show related links Why Don't Undergraduates Really "Get" Evolution? What Can ... http://www.oxfordscholarship.com.ezproxy.lib.indiana.edu/vie... of 27 6/25/13 5:37 PM If we step back from focusing just on conceptual understanding or scientific reasoning, things become more complicated. Baxter Magolda (e.g., 2004a) noted that students make meaning of their experiences using their own perspectives rather than accepting the instructor's meaning and perspective. Further, the development of more complex ways of understanding is inextricably intertwined with the development of a different and more complex sense of self and of different and of more complex ways of relating to others. "Interviewees who developed complex ways of knowing [after graduation] often could not live those ways of knowing until they had developed complex ways of seeing themselves and their relations with others" (Baxter Magolda, 2004a, p. 39). Let me stress again the importance of making extensive use of structured active learning and not just because it fosters content mastery. Appropriately structured collaborative and cooperative learning also helps foster increased cognitive sophistication and the other changes that are essential to that cognitive development. I found two techniques to be especially powerful in fostering cognitive development: 1. In teaching evolution to seniors, I developed a worksheet based on Perry's descriptions of the cognitive tasks required for deep understanding (Nelson, 2010a), and had students complete the worksheet outside of class. Then, I implemented a whole-period discussion of applications of Perry's principles, a discussion that fostered deep rethinking with peers. 2. In courses ranging from first-year to graduate, I had the students either discuss excerpts from Perry's (1970) book including his summary of the student's experience (Nelson, 2010a) or presented and had them discuss and repeatedly refer back to a graphical synopsis of Perry (as in Nelson, 2010b). Using either approach, I repeatedly asked students how a person would respond to the evolution-creation controversy (and to other issues) from the perspective of an absolutist, versus from multiplicity, versus, in turn, from contextual knowing and, later, from self-authorship In summary, the answer to the question "What can faculty do to increase the proportion of students who 'get' evolution?" from this fourth perspective is that faculty need to design their courses to foster greater cognitive sophisticati

The RIG-I-like Receptor LGP2 Controls CD8+ T Cell Survival and Fitness

SummaryThe RIG-I-like receptors (RLRs) signal innate immune defenses upon RNA virus infection, but their roles in adaptive immunity have not been clearly defined. Here, we showed that the RLR LGP2 was not essential for induction of innate immune defenses, but rather was required for controlling antigen-specific CD8+ T cell survival and fitness during peripheral T cell-number expansion in response to virus infection. Adoptive transfer and biochemical studies demonstrated that T cell-receptor signaling induced LGP2 expression wherein LGP2 operated to regulate death-receptor signaling and imparted sensitivity to CD95-mediated cell death. Thus, LGP2 promotes an essential prosurvival signal in response to antigen stimulation to confer CD8+ T cell-number expansion and effector functions against divergent RNA viruses, including West Nile virus and lymphocytic choriomeningitis virus

The Effects of Serotonin Receptor Antagonists on Contraction and Relaxation Responses Induced by Electrical Stimulation in the Rat Small Intestine

Background: The main source of 5-HT in body is in enterchromafin cells of intestine, different studies mentioned different roles for endogenous 5-HT and receptors involved and it is not clearified the mechanism of action of endogenous 5-HT. Objectives: To study the role of endogenous 5-HT on modulation of contraction and relaxation responses induced by electrical field stimulation (EFS) in different regions of the rat intestine. Materials and Methods: Segments taken from the rat duodenum, jejunum, mid and terminal ileum were vertically mounted, connected to a transducer and exposed to EFS with different frequencies in the absence and presence of various inhibitors of enteric mediators i. e. specific 5-HT receptor antagonists. Results: EFS-induced responses were sensitive to TTX and partly to atropine, indicating a major neuronal involvement and a cholinergic system. Pre-treatment with WAY100635 (a 5-HT1A receptor antagonist) and granisetron up to 10.0 µM, GR113808 (a 5-HT4 receptor antagonist), methysergide and ritanserin up to 1.0 µM, failed to modify responses to EFS inall examined tissues. In the presence of SB258585 1.0 µM (a 5-HT6 receptor antagonist) there was a trend to enhance contraction in the proximal part of the intestine and reduce contraction in the distal part. Pre-treatment with SB269970A 1.0 µM (5-HT7 receptor antagonist) induced a greater contractile response to EFS at 0.4 Hz only in the duodenum. Conclusions: The application of 5-HT1A, 5-HT2, 5-HT3, 5-HT4, 5-HT6 and 5-HT7 receptor antagonists, applied at concentrations lower than 1.0 µM did not modify the EFS-induced contraction and relaxation responses, whichsuggests the unlikely involvement of endogenous 5-HT in mediating responses to EFS in the described test conditions. Keywords: Electric Stimulation Therapy; Serotonin 5-HT1 Receptor Antagonists; Intestine, Smal

Maintaining the Strength of American Capitalism

The American economic system has always been the foundation of our national strength. But this foundation is showing cracks—from high levels of income inequality, declining economic mobility, and persistent economic insecurity among low- and middle-income Americans.Many now conclude that our economic system is broken. Recent polling data show that trust in capitalism is declining, especially among younger people. A 2018 Gallup poll found that less than half of respondents (45%) ages 18-29 held positive views of capitalism. This shift represents a 20-point decline since 2010 in the share of young adults' who held positive views of capitalism.The upshot is clear: American capitalism is in trouble. We need to strengthen our system to ensure that more people participate in our economic success. This means updating and adjusting our policies to ensure the outcomes of our market-based economy are consistent with fundamental American values of freedom, opportunity, and equality.Doing so isn't just an imperative for economic reasons. We believe that strengthening capitalism is as important for the health of the American economy as it is for the strength of our democracy. High levels of economic inequality will only contribute to increasing political dysfunction.The essays contained in this volume seek to clarify the lines of debate on some of the greatest economic policy challenges of our time and present evidence- based analysis on how to address them. It examines the hypothesis that growing market concentration is inhibiting a dynamic and competitive economy. Next, it examines the health of America's fiscal situation and what it implies about the continued strength of our market-based economy. Finally, it takes a hard look at recent policy proposals that would dramatically raise taxes on the rich and expand access to public benefit programs in response to high levels of income inequality and declining economic mobility.The perspectives presented in this volume are not intended to represent the consensus view of Aspen Economic Strategy Group members. Our goal is to equip policymakers with the best analysis available to better inform decision making and to help Americans better understand the difficult trade-offs our leaders face in making such decisions.There is no single solution to the challenges facing the American economy. The important role of evidence-based policies with bipartisan appeal, however, is difficult to overstate. This volume cannot claim to represent the end of thinking on ways to strengthen American capitalism, but we believe it provides a useful start

GWAS on family history of Alzheimer’s disease

Alzheimer’s disease (AD) is a public health priority for the 21st century. Risk reduction currently revolves around lifestyle changes with much research trying to elucidate the biological underpinnings. We show that self-report of parental history of Alzheimer’s dementia for case ascertainment in a genome-wide association study of 314,278 participants from UK Biobank (27,696 maternal cases, 14,338 paternal cases) is a valid proxy for an AD genetic study. After meta-analysing with published consortium data (n = 74,046 with 25,580 cases across the discovery and replication analyses), three new AD-associated loci (P < 5 × 10−8) are identified. These contain genes relevant for AD and neurodegeneration: ADAM10, BCKDK/KAT8 and ACE. Novel gene-based loci include drug targets such as VKORC1 (warfarin dose). We report evidence that the association of SNPs in the TOMM40 gene with AD is potentially mediated by both gene expression and DNA methylation in the prefrontal cortex. However, it is likely that multiple variants are affecting the trait and gene methylation/expression. Our discovered loci may help to elucidate the biological mechanisms underlying AD and, as they contain genes that are drug targets for other diseases and disorders, warrant further exploration for potential precision medicine applications

A process for developing a sustainable and scalable approach to community engagement : community dialogue approach for addressing the drivers of antibiotic resistance in Bangladesh

BACKGROUND: Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example. METHODS: The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed formative research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household survey - which drew on the qualitative findings - to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level. RESULTS: A community engagement intervention was co-produced and was explicitly designed to link into existing health system and community structures and be appropriate for the cultural context, and therefore have the potential to be implemented at scale. We anticipate that taking this approach increases local ownership, as well as the likelihood that the intervention will be sustainable and scalable. CONCLUSIONS: This study demonstrates the value of ensuring that a range of stakeholders co-produce the intervention, and ensuring that the intervention is designed to be appropriate for the health system, community and cultural context

Physical capability and subsequent positive mental wellbeing in older people: Findings from five HALCyon cohorts

Objective measures of physical capability are being used in a growing number of studies as biomarkers of healthy ageing. However, very little research has been done to assess the impact of physical capability on subsequent positive mental wellbeing, the maintenance of which is widely considered to be an essential component of healthy ageing. We aimed to test the associations of grip strength and walking, timed get up and go and chair rise speeds (assessed at ages 53 to 82 years) with positive mental wellbeing assessed using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS) 5 to 10 years later. Data were drawn from five British cohorts participating in the Healthy Ageing across the Life Course research collaboration. Data from each study were analysed separately and then combined using random-effects meta-analyses. Higher levels of physical capability were consistently associated with higher subsequent levels of wellbeing; for example, a 1SD increase in grip strength was associated with an age and sex-adjusted mean difference in WEMWBS score of 0.81 (0.25, 1.37), equivalent to 10 % of a standard deviation (three studies, N = 3,096). When adjusted for body size, health status, living alone, socioeconomic position and neuroticism the associations remained albeit attenuated. The finding of these consistent modest associations across five studies, spanning early and later old age, highlights the importance of maintaining physical capability in later life and provides additional justification for using objective measures of physical capability as markers of healthy ageing

Diabetes MILES - Australia (Management and Impact for Long-Term Empowerment and Success) : methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults

Background Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study is an international collaborative. Diabetes MILES-Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes on their lives, as well as to use the data to validate new diabetes outcome measures.Methods The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys. Cognitive debriefing interviews with 20 participants ensured the survey content was relevant and easily understood. In July 2011, the survey was posted to 15,000 adults (aged 18-70 years) with type 1 or type 2 diabetes selected randomly from the National Diabetes Services Scheme (NDSS) database. An online version of the survey was advertised nationally. A total of 3,338 eligible Australians took part; most (70.4%) completed the postal survey. Respondents of both diabetes types and genders, and of all ages, were adequately represented in both the postal and online survey sub-samples. More people with type 2 diabetes than type 1 diabetes took part in Diabetes MILES-Australia (58.8% versus 41.2%). Most respondents spoke English as their main language, were married/in a de facto relationship, had at least a high school education, were occupied in paid work, had an annual household income &gt; $AUS40,000, and lived in metropolitan areas.Discussion A potential limitation of the study is the under-representation of respondents from culturally and linguistically diverse backgrounds (including Aboriginal and Torres Strait Islander origin). Diabetes MILES-Australia represents a major achievement in the study of diabetes in Australia, where for the first time, the focus is on psychosocial and behavioural aspects of this condition at a national level. <br /