ATII GAMESHOW, Healthy Living Intervention for School Children in Nunavut: Evaluation Report

The purpose of this project was to improve the ability of Inuit children to make healthy choices about food and activity and carry health knowledge forward with them into adolescence and adulthood; to improve health literacy in Inuktitut; to engage children in a fun, team-style health promotion game; to promote and evaluate a local intervention developed by young, motivated Inuit youth workers in Nunavut.; to hire and train youth to lead and implement and deliver the intervention

The Relationship between Airport Infrastructure and Flight Arrivals in Remote Northern Canadian Communities

Much of Canada’s northern population resides in communities that are inaccessible by road for a substantial portion of the year. Residents of these “fly-in” communities rely on aircraft to provide a wide range of social, economic, and transportation services. However, for numerous reasons, including the often extreme environmental conditions in the circumpolar regions of Canada, a substantial number of flights to these communities are cancelled or diverted. Using a dataset from two airlines that serve the western portion of this region with information about schedules, delays, and cancellations of more than 18 500 flights, we examined the links between airport infrastructure, flight arrival reliability, and a variety of socioeconomic variables in 23 northern communities. Results show that runway length has a significant impact on the reliability of flight arrival, but also that the reliability of flights may not affect the cost of food in the communities included in our analysis. These findings provide evidence that lengthening runways could improve air service in the Canadian North. Une grande partie de la population du Nord canadien réside dans des localités inaccessibles par voie terrestre pendant une grande partie de l’année. Les habitants de ces localités desservies par voie aérienne dépendent des avions pour une vaste gamme de services sociaux, économiques et de transport. Toutefois, pour maintes raisons, dont les conditions environnementales souvent extrêmes qui sévissent dans les régions circumpolaires du Canada, un grand nombre de vols à destination de ces localités est annulé ou dévié. En nous appuyant sur des données en provenance de deux sociétés aériennes qui desservent ces régions, données portant sur les horaires de vol, les retards et les annulations concernant plus de 18 500 vols, nous avons examiné les liens entre les infrastructures aéroportuaires, la fiabilité de l’arrivée des vols et un éventail de variables socioéconomiques propres à 23 localités nordiques. Les résultats ont permis de constater que la longueur des pistes exerce une grande incidence sur la fiabilité de l’arrivée des vols, mais aussi, que la fiabilité des vols n’a pas nécessairement d’influence sur le coût des aliments dans les localités visées par notre analyse. Grâce à ces constatations, nous pouvons soutenir que l’allongement des pistes pourrait améliorer les dessertes aériennes dans le Nord canadien

Strengthening Sustainable Northern Food Systems: Federal Policy Constraints and Potential Opportunities

This paper explores how Canadian federal policy and frameworks can better support community-based initiatives to reduce food insecurity and build sustainable food systems in the North. Through an examination of the current state of food systems infrastructure, transportation, harvest, and production in the Yukon, Northwest Territories, Nunavut, Nunavik, and Nunatsiavut, we argue in favour of a multi-sector approach that supports diversified food systems, including traditional/country food production and distribution, in a way that values and prioritizes community-led initiatives and Indigenous peoples’ self-determination and self-governance. The challenge of developing sustainable, northern food systems requires made-in-the-North solutions that are attuned to cultural, geographic, environmental, and political contexts. Recent policy developments suggest some progress in this direction, however much more work is needed. Ultimately, sustainable northern food systems must be defined by and for Northerners at community, local, and regional levels, with particular attention paid to treaty rights and the right to self-determination of First Nations and other Indigenous communities.Cet article se penche sur la manière dont les politiques et les cadres de référence fédéraux du Canada peuvent mieux soutenir les initiatives communautaires afin d’atténuer l’insécurité alimentaire et d’édifier des systèmes alimentaires durables dans le Nord. En nous appuyant sur l’examen de l’état actuel de l’infrastructure des systèmes alimentaires, du transport, des récoltes et de la production du Yukon, des Territoires du Nord-Ouest, du Nunavut, du Nunavik et du Nunatsiavut, nous plaidons en faveur d’une approche multisectorielle favorisant des systèmes alimentaires diversifiés, y compris la production et la distribution d’aliments traditionnels ou du terroir, valorisant et priorisant les initiatives communautaires de même que l’autodétermination et l’autonomie gouvernementale des peuples autochtones. Le défi consistant à concevoir des systèmes alimentaires durables dans le Nord nécessite des solutions provenant du Nord, solutions qui tiennent compte des contextes culturel, géographique, environnemental et politique. De récents développements en matière de politiques suggèrent un certain progrès, mais il reste toutefois fort à faire dans ce sens. Au bout du compte, les systèmes alimentaires durables dans le Nord doivent être définis par et pour les gens du Nord à l’échelle communautaire, locale et régionale, en accordant une attention particulière aux droits issus des traités ainsi qu’au droit à l’autodétermination des Premières Nations et d’autres collectivités autochtones

Promotion of physical activity in rural, remote and northern settings: a Canadian call to action

Introduction: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings. Methods: We conducted a “synopses of syntheses” scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action. Results: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the priority-setting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities. Conclusion: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action

Reproductive toxicity of the water accommodated fraction (WAF) of crude oil in the polychaetes Arenicola marina (L.) and Nereis virens (Sars).

addresses: School of Biosciences, Hatherley Laboratories, University of Exeter, Prince of Wales Road, Exeter EX4 4PS, UK. [email protected]: Journal Article; Research Support, Non-U.S. Gov'tCopyright © 2008 Elsevier. NOTICE: This is the author’s version of a work accepted for publication by Elsevier. Changes resulting from the publishing process, including peer review, editing, corrections, structural formatting and other quality control mechanisms, may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Aquatic Toxicology, 2008, Vol. 90, Issue 1, pp. 73 – 81 DOI: http://dx.doi.org/10.1016/j.aquatox.2008.08.001Accidental pollution incidents are common in the marine environment and are often caused by oil-related activities. Here the potential of such an incident to disrupt reproduction in two polychaete species is investigated, using an environmentally relevant preparation of weathered Forties crude oil, i.e. the water accommodated fraction (WAF). Oocytes were collected and exposed to three concentrations of WAF for 1h prior to the addition of sperm, so that fertilization took place under exposure conditions. Fertilization success was significantly reduced in both species by an exposure to WAF concentrations equivalent to 0.38 mgL(-1) PAHs, to just 26.8% in Arenicola marina compared to 76% in Nereis virens. The effects of WAF exposure on fertilization were greatly enhanced at lower sperm concentrations in N. virens, with a complete lack of fertilization reactions observed at sperm concentrations of 10(3)sperm per mL. We therefore suggest a mechanism of toxicity related to sperm swimming behaviour, resulting in reduced sperm:egg collision rates. WAF was found to reduce post-fertilization development rates and have teratogenic effects on early embryonic stages in both species, which exhibited abnormal cleavage patterns and high levels of fluctuating asymmetry. These results illustrate how the presence of crude oil in its soluble form in seawater at the time of a spawning event for either A. marina or N. virens could impact on fertilization success with implications for the fertilization ecology of these free spawning marine invertebrates

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes