What predicts persistent early conduct problems? Evidence from the Growing Up in Scotland cohort

Background: There is a strong case for early identification of factors predicting life-course-persistent conduct disorder. The authors aimed to identify factors associated with repeated parental reports of preschool conduct problems. Method: Nested caseecontrol study of Scottish children who had behavioural data reported by parents at 3, 4 and 5 years. Results: 79 children had abnormal conduct scores at all three time points ('persistent conduct problems') and 434 at one or two points ('inconsistent conduct problems'). 1557 children never had abnormal scores. Compared with children with no conduct problems, children with reported problems were significantly more likely to have mothers who smoked during pregnancy. They were less likely to be living with both parents and more likely to be in poor general health, to have difficulty being understood, to have a parent who agrees that smacking is sometimes necessary and to be taken to visit other people with children rarely. The results for children with persistent and inconsistent conduct problems were similar, but associations with poverty and maternal smoking were significantly less strong in the inconsistent group. Conclusion: These factors may be valuable in early identification of risk of major social difficulties

Developing a competency-based approach to facilitate teaching and learning of antimicrobial stewardship as part of environmental sustainability in higher education.

The environmental impact of the inappropriate use of antimicrobials and antimicrobial resistance (AMR) is recognised by global organisations, such as the World Health Organisation and the European Union. Antimicrobial stewardship (AMS) is one strategy to promote appropriate use of antimicrobials to minimise AMR and is a priority for the NHS to ensure sustainable prescribing. It is therefore imperative to support and empower future health care professionals by providing them with the knowledge to be leaders in the field of AMS. National consensus-based competencies for teaching AMS to undergraduate healthcare professionals in the UK were launched in 2018. This generic framework includes competencies relating to specific aspects of antimicrobial prescribing and infection control, and also emphasizes the importance of collaborative interprofessional working. The aim of this project is to determine which AMS competencies are required to be met by student pharmacists. This pedagogic approach will provide a guiding tool for curricula development, and will allow identification of gaps and strengths within the undergraduate pharmacy curriculum. To enable the development of a UK-wide national AMS competency framework specifically for student pharmacists, a working group of academics and pharmacy practitioners with expertise in AMS was set up in September 2022. The diverse backgrounds of group members provide a healthy mix of ideas, with academics informing the group of what may be achievable within the constraints and professional requirements of the pharmacy curriculum, and pharmacy practitioners providing input into essential AMS competencies for early-career pharmacists. Student pharmacists from a national organisation are being invited to join the group to encourage co-designing of this curriculum. Considering the UN commitment to act on global antimicrobial resistance and the NHS Sustainable Development management plan, this project is timely and of great importance to support development of future pharmacists as leaders in environmental sustainability

RESTORE-IMI 1: A Multicenter, Randomized, Doubleblind Trial Comparing Efficacy and Safety of Imipenem/Relebactam vs Colistin Plus Imipenem in Patients With Imipenem-nonsusceptible Bacterial Infections

Background. The β-lactamase inhibitor relebactam can restore imipenem activity against imipenem-nonsusceptible gram-negative pathogens. We evaluated imipenem/relebactam for treating imipenem-nonsusceptible infections. Methods. Randomized, controlled, double-blind, phase 3 trial. Hospitalized patients with hospital-acquired/ventilatorassociated pneumonia, complicated intraabdominal infection, or complicated urinary tract infection caused by imipenemnonsusceptible (but colistin- and imipenem/relebactam-susceptible) pathogens were randomized 2:1 to 5–21 days imipenem/ relebactam or colistin+imipenem. Primary endpoint: favorable overall response (defined by relevant endpoints for each infection type) in the modified microbiologic intent-to-treat (mMITT) population (qualifying baseline pathogen and ≥1 dose study treatment). Secondary endpoints: clinical response, all-cause mortality, and treatment-emergent nephrotoxicity. Safety analyses included patients with ≥1 dose study treatment. Results. Thirty-one patients received imipenem/relebactam and 16 colistin+imipenem. Among mITT patients (n = 21 imipenem/relebactam, n = 10 colistin+imipenem), 29% had Acute Physiology and Chronic Health Evaluation II scores >15, 23% had creatinine clearance <60 mL/min, and 35% were aged ≥65 years. Qualifying baseline pathogens: Pseudomonas aeruginosa (77%), Klebsiella spp. (16%), other Enterobacteriaceae (6%). Favorable overall response was observed in 71% imipenem/relebactam and 70% colistin+imipenem patients (90% confidence interval [CI] for difference, –27.5, 21.4), day 28 favorable clinical response in 71% and 40% (90% CI, 1.3, 51.5), and 28-day mortality in 10% and 30% (90% CI, –46.4, 6.7), respectively. Serious adverse events (AEs) occurred in 10% of imipenem/relebactam and 31% of colistin+imipenem patients, drug-related AEs in 16% and 31% (no drugrelated deaths), and treatment-emergent nephrotoxicity in 10% and 56% (P = .002), respectively. Conclusions. Imipenem/relebactam is an efficacious and well-tolerated treatment option for carbapenem-nonsusceptible infection

The RESET project: constructing a European tephra lattice for refined synchronisation of environmental and archaeological events during the last c. 100 ka

This paper introduces the aims and scope of the RESET project (. RESponse of humans to abrupt Environmental Transitions), a programme of research funded by the Natural Environment Research Council (UK) between 2008 and 2013; it also provides the context and rationale for papers included in a special volume of Quaternary Science Reviews that report some of the project's findings. RESET examined the chronological and correlation methods employed to establish causal links between the timing of abrupt environmental transitions (AETs) on the one hand, and of human dispersal and development on the other, with a focus on the Middle and Upper Palaeolithic periods. The period of interest is the Last Glacial cycle and the early Holocene (c. 100-8 ka), during which time a number of pronounced AETs occurred. A long-running topic of debate is the degree to which human history in Europe and the Mediterranean region during the Palaeolithic was shaped by these AETs, but this has proved difficult to assess because of poor dating control. In an attempt to move the science forward, RESET examined the potential that tephra isochrons, and in particular non-visible ash layers (cryptotephras), might offer for synchronising palaeo-records with a greater degree of finesse. New tephrostratigraphical data generated by the project augment previously-established tephra frameworks for the region, and underpin a more evolved tephra 'lattice' that links palaeo-records between Greenland, the European mainland, sub-marine sequences in the Mediterranean and North Africa. The paper also outlines the significance of other contributions to this special volume: collectively, these illustrate how the lattice was constructed, how it links with cognate tephra research in Europe and elsewhere, and how the evidence of tephra isochrons is beginning to challenge long-held views about the impacts of environmental change on humans during the Palaeolithic. © 2015 Elsevier Ltd.RESET was funded through Consortium Grants awarded by the Natural Environment Research Council, UK, to a collaborating team drawn from four institutions: Royal Holloway University of London (grant reference NE/E015905/1), the Natural History Museum, London (NE/E015913/1), Oxford University (NE/E015670/1) and the University of Southampton, including the National Oceanography Centre (NE/01531X/1). The authors also wish to record their deep gratitude to four members of the scientific community who formed a consultative advisory panel during the lifetime of the RESET project: Professor Barbara Wohlfarth (Stockholm University), Professor Jørgen Peder Steffensen (Niels Bohr Institute, Copenhagen), Dr. Martin Street (Romisch-Germanisches Zentralmuseum, Neuwied) and Professor Clive Oppenheimer (Cambridge University). They provided excellent advice at key stages of the work, which we greatly valued. We also thank Jenny Kynaston (Geography Department, Royal Holloway) for construction of several of the figures in this paper, and Debbie Barrett (Elsevier) and Colin Murray Wallace (Editor-in-Chief, QSR) for their considerable assistance in the production of this special volume.Peer Reviewe

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Recent pine woodland dynamics in east Glen Affric, northern Scotland, from highly resolved palaeoecological analyses

Glen Affric, a National Nature Reserve of international conservation importance for plant and animal communities associated with Scots pine (Pinus sylvestris) woodland is managed for nature conservation and woodland restoration at a landscape scale. Management plans have drawn on information on current stand structure and variation but have not used in any detailed way the analyses of past tree population changes from sources, such as pollen analyses. This paper reports the results of pollen analyses from three small peat hollows at the head of Loch Beinn a' Mheadhoin. The analyses demonstrate, first, that woods in the east of the reserve several centuries ago were different in species composition and were more varied than they are today and, second, that the currently patchy Pinus wood in the west of the reserve, at the head of Loch Beinn a' Mheadhoin, is the result of recent spread westward onto former heathland. This temporal and spatial variability in the recent past has implications for the future management of the woods because future woods may not develop with the characteristics of the current stands, and may not be stable over time

Utilizing Raman Spectroscopy as a Tool for Solid-and Solution-Phase Analysis of Metalloorganic Cage Host-Guest Complexes

The host-guest chemistry of coordination cages continues to promote significant interest, not least because confinement effects can be exploited for a range of applications, such as drug delivery, sensing, and catalysis. Often a fundamental analysis of noncovalent encapsulation is required to provide the necessary insight into the design of better functional systems. In this paper, we demonstrate the use of various techniques to probe the host-guest chemistry of a novel Pd2L4 cage, which we show is preorganized to selectively bind dicyanoarene guests with high affinity through hydrogen-bonding and other weak interactions. In addition, we exemplify the use of Raman spectroscopy as a tool for analyzing coordination cages, exploiting alkyne and nitrile reporter functional groups that are contained within the host and guest, respectively