The reliability of the ankle brachial index : a systematic review

Background: The ankle brachial index (ABI) is widely used in clinical practice as a non-invasive method to detect the presence and severity of peripheral arterial disease (PAD). Current guidelines suggest that it should be used to monitor potential progression of PAD in affected individuals. As such, it is important that the test is reliable when used for repeated measurements, by the same or different health practitioners. This systematic review aims to examine the literature to evaluate the inter- and intra-rater reliability of the ABI. Methods: A systematic search of MEDLINE, EMBASE and CINAHL Complete was conducted to 20 January 2019. Two authors independently reviewed and selected relevant studies and extracted the data. Methodological quality was determined using the Quality Appraisal of Reliability (QAREL) Checklist. Results: Fifteen studies of ABI reliability in a range of patient populations were identified as suitable for inclusion in the review: seven considered inter-rater reliability, four intra-rater reliability, and four studies evaluated both inter- and intra-rater reliability. Inter-rater reliability was found to be highly variable, with intraclass correlation coefficients (ICC's) ranging from poor to excellent (ICC 0.42-1.00), while intra-rater also demonstrated considerable variation, with ICCs from 0.42-0.98. Meta-analysis was not possible due to the lack of statistical information reported. Conclusions: Results of included studies suggest the inter- and intra-tester reliability of the ABI is acceptable. However, inconsistencies in obtaining systolic pressure measurements, calculating ABI values, and incomplete reporting of methodologies and statistical analysis make it difficult to determine the validity of the results of included studies. Further research, with more consistent reliability methodology, statistical analysis and reporting conducted in populations at risk of PAD is needed to conclusively determine the ABI reliability

Review and meta-analysis of genetic polymorphisms associated with exceptional human longevity

Background Many factors contribute to exceptional longevity, with genetics playing a significant role. However, to date, genetic studies examining exceptional longevity have been inconclusive. This comprehensive review seeks to determine the genetic variants associated with exceptional longevity by undertaking meta-analyses. Methods Meta-analyses of genetic polymorphisms previously associated with exceptional longevity (85+) were undertaken. For each variant, meta-analyses were performed if there were data from at least three independent studies available, including two unpublished additional cohorts. Results Five polymorphisms, ACE rs4340, APOE ε2/3/4, FOXO3A rs2802292, KLOTHO KL-VS and IL6 rs1800795 were significantly associated with exceptional longevity, with the pooled effect sizes (odds ratios) ranging from 0.42 (APOE ε4) to 1.45 (FOXO3A males). Conclusion In general, the observed modest effect sizes of the significant variants suggest many genes of small influence play a role in exceptional longevity, which is consistent with results for other polygenic traits. Our results also suggest that genes related to cardiovascular health may be implicated in exceptional longevity. Future studies should examine the roles of gender and ethnicity and carefully consider study design, including the selection of appropriate controls

The Physical Activity 4 Everyone Cluster Randomized Trial : 2-Year Outcomes of a School Physical Activity Intervention Among Adolescents

Acknowledgments The Physical Activity 4 Everyone intervention trial was funded by the New South Wales Ministry of Health through the New South Wales Health Promotion Demonstration Research Grants Scheme and conducted by Hunter New England Population Health (a unit of the Hunter New England Local Health District), in collaboration with the University of Newcastle and University of Wollongong. Infrastructure support was provided by Hunter Medical Research Institute. The research team acknowledges the importance of making research data publically available. Access to the accelerometer data from this study may be made available to external collaborators following the development of data transfer agreements. Further results arising from the study can be found at www.goodforkids.nsw.gov.au/high-schools/. No financial disclosures were reported by the authors of this paper.Peer reviewedPublisher PD

Time-efficient physical activity intervention for older adolescents with disability : rationale and study protocol for the Burn 2 Learn adapted (B2La) cluster randomised controlled trial

Introduction Physical activity declines during adolescence, with the lowest levels of activity observed among those with disability. Schools are ideal settings to address this issue; however, few school-based interventions have been specifically designed for older adolescents with disability. Our aim is to investigate the effects of a school-based physical activity programme, involving high-intensity interval training (HIIT), on physical, mental and cognitive health in older adolescents with disability. Methods and analysis We will evaluate the Burn 2 Learn adapted (B2La) intervention using a two-arm, parallel group, cluster randomised controlled trial with allocation occurring at the school level (treatment or waitlist control). Secondary schools will be recruited in two cohorts from New South Wales, Australia. We will aim to recruit 300 older adolescents (aged 15–19 years) with disability from 30 secondary schools (10 in cohort 1 and 20 in cohort 2). Schools allocated to the intervention group will deliver two HIIT sessions per week during scheduled specialist support classes. The sessions will include foundational aerobic and muscle strengthening exercises tailored to meet student needs. We will provide teachers with training, resources, and support to facilitate the delivery of the B2La programme. Study outcomes will be assessed at baseline, 6 months (primary endpoint), and 9 months. Our primary outcome is functional capacity assessed using the 6 min walk/push test. Secondary outcomes include physical activity, muscular fitness, body composition, cognitive function, quality of life, physical literacy, and on-task behaviour in the classroom. We will also conduct economic and process evaluations to determine cost-effectiveness, programme acceptability, implementation, adaptability, and sustainability in schools. Ethics and dissemination This study has received approval from the University of Newcastle (H-2021–0262) and the New South Wales Department of Education (SERAP: 2021257) human research ethics committees. Findings will be published in peer-reviewed journals, and key stakeholders will be provided with a detailed report following the study. Trial registration number Australian New Zealand Clinical Trials Registry Number: ACTRN12621000884808

Genetic determinants of heel bone properties: genome-wide association meta-analysis and replication in the GEFOS/GENOMOS consortium

Quantitative ultrasound of the heel captures heel bone properties that independently predict fracture risk and, with bone mineral density (BMD) assessed by X-ray (DXA), may be convenient alternatives for evaluating osteoporosis and fracture risk. We performed a meta-analysis of genome-wide association (GWA) studies to assess the genetic determinants of heel broadband ultrasound attenuation (BUA; n = 14 260), velocity of sound (VOS; n = 15 514) and BMD (n = 4566) in 13 discovery cohorts. Independent replication involved seven cohorts with GWA data (in silico n = 11 452) and new genotyping in 15 cohorts (de novo n = 24 902). In combined random effects, meta-analysis of the discovery and replication cohorts, nine single nucleotide polymorphisms (SNPs) had genome-wide significant (P < 5 × 10(-8)) associations with heel bone properties. Alongside SNPs within or near previously identified osteoporosis susceptibility genes including ESR1 (6q25.1: rs4869739, rs3020331, rs2982552), SPTBN1 (2p16.2: rs11898505), RSPO3 (6q22.33: rs7741021), WNT16 (7q31.31: rs2908007), DKK1 (10q21.1: rs7902708) and GPATCH1 (19q13.11: rs10416265), we identified a new locus on chromosome 11q14.2 (rs597319 close to TMEM135, a gene recently linked to osteoblastogenesis and longevity) significantly associated with both BUA and VOS (P < 8.23 × 10(-14)). In meta-analyses involving 25 cohorts with up to 14 985 fracture cases, six of 10 SNPs associated with heel bone properties at P < 5 × 10(-6) also had the expected direction of association with any fracture (P < 0.05), including three SNPs with P < 0.005: 6q22.33 (rs7741021), 7q31.31 (rs2908007) and 10q21.1 (rs7902708). In conclusion, this GWA study reveals the effect of several genes common to central DXA-derived BMD and heel ultrasound/DXA measures and points to a new genetic locus with potential implications for better understanding of osteoporosis pathophysiology

Problematic Attachment to Social Media: Lived Experience and Emotions

People's relationship with social media and their contacts on them can be problematic. People may engage in social media in a compulsive and hasty style to increase their popularity, reputation and enhance their self-esteem. However, this problematic attachment to social media may result in side effects on people’s well-being. Therefore, people may need assistance to reform their relationship with social media in a way that it maintains different aspects of their online interaction, such as empathy with others and maintaining their popularity and relatedness. In order to provide the tools and methods to support people in reforming their relationship with social media, towards a healthier usage style, we need to understand the experience of people who suffer a problematic relationship with them. Most studies on the topic are based on methods which would lack ecological validity, e.g. using surveys and interviews, and do not capture or imitate such a digital experience as lived. In an attempt to better explore how people experience problematic attachment and relationship with social media, and their associated emotions, we conducted a multistage qualitative method study including a diary study to gather lived experience. We aim to inform both users and designers towards a managed and tool-supported reform of their problematic relationship with social media and, ultimately, having a healthier online interaction

Exploring individual differences in online addictions: the role of identity and attachment

Research examining the development of online addictions has grown greatly over the last decade with many studies suggesting both risk factors and protective factors. In an attempt to integrate the theories of attachment and identity formation, the present study investigated the extent to which identity styles and attachment orientations account for three types of online addiction (i.e., internet addiction, online gaming addiction, and social media addiction). The sample comprised 712 Italian students (381 males and 331 females) recruited from schools and universities who completed an offline self-report questionnaire. The findings showed that addictions to the internet, online gaming, and social media were interrelated and were predicted by common underlying risk and protective factors. Among identity styles, 'informational' and 'diffuse-avoidant' styles were risk factors, whereas 'normative' style was a protective factor. Among attachment dimensions, the 'secure' attachment orientation negatively predicted the three online addictions, and a different pattern of causal relationships were observed between the styles underlying 'anxious’ and 'avoidant' attachment orientations. Hierarchical multiple regressions demonstrated that identity styles explained between 21.2 and 30% of the variance in online addictions, whereas attachment styles incrementally explained between 9.2 and 14% of the variance in the scores on the three addiction scales. These findings highlight the important role played by identity formation in the development of online addictions

The humanistic roots of Islamic administration and leadership for education : philosophical foundations for cross-cultural and transcultural teaching

For a number of decades, a humanistic approach has been a minor but persistent one in the Western field of administrative and leadership studies, and only recently has been broadening to include other humanist traditions (Dierksmeier et al., 2011) and has yet to be fully explored in educational administration and its pedagogy and curriculum although some foundational work has been done (e.g., Samier, 2005). The focus in this chapter is on the Islamic humanist tradition as it relates to the teaching of educational administration and leadership in a Muslim context, with implications for cross-cultural and transcultural use. The second purpose of the chapter is to show the correspondences that exist between the Islamic and Western humanist traditions in terms of human values, knowledge and educational ideal, which in this chapter are argued to be close to the Western Idealist tradition and the German Bildung conception of education as well as the strong interpretive and hermeneutic foundations that originated in the Islamic tradition and which influenced the foundations of many relevant European schools of thought, particularly in the Enlightenment.The initial section of the chapter is a comparative examination of the central principles of the Islamic humanist tradition from the classical through to contemporary times with the Western humanist tradition as they relate to conceptions of the good, ethics, the construction of meaning and a set of higher order values predicated upon human dignity, integrity, empathy, well-being, and the public good (Goodman, 2003) covering a number of important scholars like Al Farabi, al Isfanhani, and Edward Said (e.g., Kraemer, 1986). In both, professions are viewed as meaningful work that allow for large measures of decision making, and are grounded in human qualities and needs including autonomy, freedom and emancipation balanced with responsibilities, obligations and duties to society. These are compared with the corresponding principles of knowledge in Western humanism which includes a strong constructivist view of reality (Makdisi, 1990). Secondly, the chapter examines the principles of good or ideal leadership and administration that humanism aims at in its preparation of officials, including those in the educational sector in both the classical Islamic tradition (Hassi, 2012) and Western approaches to humanistic administration and leadership (Czarniawska-Joerges & Guillet de Monthoux, 1994; Gagliardi & Czarniawska, 2006; Leoussi, 2000). The third section focusses on close correspondences that exist between the Islamic (Afsaruddin, 2016; al-Attas, 1980; Yasin & Jani, 2013) and Western (Aloni, 2007; Veugelers, 2011) humanist education traditions in terms of educational ideal as well as the kind of teaching practices that distinguish these traditions (Daiber, 2013; Dossett, 2014) as they apply to educational administration and leadership (Greenfield & Ribbins, 1993). The chapter concludes with a discussion of how the Islamic humanist tradition can contribute to cross-cultural and transcultural graduate teaching in international educational administration (Khan & Amann, 2013)

Unexpected Inheritance: Multiple Integrations of Ancient Bornavirus and Ebolavirus/Marburgvirus Sequences in Vertebrate Genomes

Vertebrate genomes contain numerous copies of retroviral sequences, acquired over the course of evolution. Until recently they were thought to be the only type of RNA viruses to be so represented, because integration of a DNA copy of their genome is required for their replication. In this study, an extensive sequence comparison was conducted in which 5,666 viral genes from all known non-retroviral families with single-stranded RNA genomes were matched against the germline genomes of 48 vertebrate species, to determine if such viruses could also contribute to the vertebrate genetic heritage. In 19 of the tested vertebrate species, we discovered as many as 80 high-confidence examples of genomic DNA sequences that appear to be derived, as long ago as 40 million years, from ancestral members of 4 currently circulating virus families with single strand RNA genomes. Surprisingly, almost all of the sequences are related to only two families in the Order Mononegavirales: the Bornaviruses and the Filoviruses, which cause lethal neurological disease and hemorrhagic fevers, respectively. Based on signature landmarks some, and perhaps all, of the endogenous virus-like DNA sequences appear to be LINE element-facilitated integrations derived from viral mRNAs. The integrations represent genes that encode viral nucleocapsid, RNA-dependent-RNA-polymerase, matrix and, possibly, glycoproteins. Integrations are generally limited to one or very few copies of a related viral gene per species, suggesting that once the initial germline integration was obtained (or selected), later integrations failed or provided little advantage to the host. The conservation of relatively long open reading frames for several of the endogenous sequences, the virus-like protein regions represented, and a potential correlation between their presence and a species' resistance to the diseases caused by these pathogens, are consistent with the notion that their products provide some important biological advantage to the species. In addition, the viruses could also benefit, as some resistant species (e.g. bats) may serve as natural reservoirs for their persistence and transmission. Given the stringent limitations imposed in this informatics search, the examples described here should be considered a low estimate of the number of such integration events that have persisted over evolutionary time scales. Clearly, the sources of genetic information in vertebrate genomes are much more diverse than previously suspected