Results From Wales’ 2018 Report Card on Physical Activity for Children and Youth

This is the third Active Healthy Kids Wales (AHK-Wales) Report Card following the inaugural and second report card published in 2014 and 2016 respectively.1,2 The 2018 report card (Figure 1) consolidates and translates research related to physical activity among children and young people in Wales. The report card aimed to raise the awareness of children and young people’s engagement in physical activity behaviours and influences, and advocate for children’s right to be active and healthy

IMBeR into the future Science Plan and Implementation Strategy 2016-2025

The Integrated Marine Biosphere Research (IMBeR) project, formerly the Integrated Marine Biogeochemistry and Ecosystem Research (IMBER1) project, is a global environmental change research initiative. Since its start in 2005, IMBeR has advanced understanding about potential marine environmental effects of global change, and the impacts and linkages to human systems at multiple scales. It is apparent that complex environmental issues and associated societal/sustainability choices operate at and across the interfaces of natural and social sciences and the humanities, and require both basic, curiosity-driven research and problem-driven, policy-relevant research. Collaborative, disciplinary, interdisciplinary, transdisciplinary and integrated research that addresses key ocean science issues generated by and/or impacting society is required to provide evidence-based knowledge and guidance, along with options for policy-makers, managers and marine-related communities, to help achieve sustainability of the marine realm under global change. This recognition underlies a new vision, “Ocean sustainability under global change for the benefit of society”, to guide IMBeR research for the next decade (2016-2025). This vision recognises that the evolution of marine ecosystems (including biogeochemical cycles and human systems) is linked to natural and anthropogenic drivers and stressors, as articulated in the new IMBeR research goal to, “Understand, quantify and compare historic and present structure and functioning of linked ocean and human systems to predict and project changes including developing scenarios and options for securing or transitioning towards ocean sustainability”. To implement its new vision and goal in the next decade, IMBeR’s mission is to, “Promote integrated marine research and enable capabilities for developing and implementing ocean sustainability options within and across the natural and social sciences, and communicate relevant information and knowledge needed by society to secure sustainable, productive and healthy oceans”. This Science Plan and Implementation Strategy provides a 10-year (2016-2025) marine research agenda for IMBeR. It is developed around three Grand Challenges (GC, see Graphical Executive Summary) focusing on climate variability, global change and drivers and stressors. The qualitative and quantitative understanding of historic and present ocean variability and change (Grand Challenge I) are the basis for scenarios, projections and predictions of the future (Grand Challenge II). These are linked in Grand Challenge III to understand how humans are causing the variability and changes, and how they, in turn, are impacted by these changes, including feedbacks between the human and ocean systems. Priority research areas with overarching and specific research questions are identified for each Grand Challenge. The Grand Challenges are supplemented with Innovation Challenges (IC, see graphical executive summary) that focus on new topics for IMBeR where research is needed and where it is believed that major achievements can be made within three to five years. The Innovation Challenges also provide a means for IMBeR to adjust its focus as major science discoveries are made and new priorities arise, especially regarding scientific innovations

Feminist Economics, Setting out the Parameters

___Introduction___ Feminist economics has developed its position over the past decade, towards a firmer embeddedness in economic science and a source of inspiration for activists, policy makers, and social science researchers in a wide variety of fields of research. This development has come about in a relatively short period of time, as is reflected, for example, in the follow-up book of the feminist economic primer Beyond Economic Man (Ferber/Nelson 1993), published ten years later: Feminist Economics Today (Ferber/Nelson, 2003) The strengthened position of feminist economics also shows in the 10-year anniversary of the prize-winning journal Feminist Economics, the flourishing of the International Association for Feminist Economics (IAFFE), as well as the more regular demand for feminist economic policy advise by institutions like the UN, OECD and governments in developed and developing countries, and in well-established training courses in feminist economics, such as at the Institute of Social Studies and University of Utah . It is impossible to give a fair overview of the state of the art of feminist economics in the number of pages available, even when limited to issues pertaining to development and macroeconomics . As a consequence, this is a very sketchy and subjective overview of what I perceive to be recent developments in feminist economics that have relevance for feminist development analysis and policy. The next section recognizes three trends in feminist economics, in particular the engagement of feminist economists with heterodox schools of economics. The following sections will briefly review developments in methodology and methods in feminist economics. These will be followed by three sections on topics that have recently become key themes or areas of research in feminist economics, in particular in the area of development economics: unpaid labour and the care economy; the two-way relationship between gender and trade; and gender, efficiency and growth. Each of these topics will be introduced, with references to the main literature, and some links to policy recommendations. The paper will end with a conclusion

Technically advanced and SF6-free 145 kV blue GIS

SF6, the most commonly used arc extinguishing and insulating gas in gas-insulated switchgears (GIS), is a greenhouse gas with high global warming potential, requiring careful handling throughout its life cycle. In order to reduce the GIS-related global warming impact, innovative solutions using alternative gases have been developed by different manufacturers, especially the blue GIS from Siemens – available for 145 kV / 40 kA / 3150 A – with clean air insulation and vacuum switching technology shows many technical advantages

Phase II Study of Lapatinib in Combination With Trastuzumab in Patients With Human Epidermal Growth Factor Receptor 2–Positive Metastatic Breast Cancer: Clinical Outcomes and Predictive Value of Early [ 18 F]Fluorodeoxyglucose Positron Emission Tomography Imaging (TBCRC 003)

Lapatinib plus trastuzumab improves outcomes relative to lapatinib alone in heavily pretreated, human epidermal growth factor receptor 2–positive metastatic breast cancer (MBC). We tested the combination in the earlier-line setting and explored the predictive value of [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) for clinical outcomes

A Decade of Incorporating Social Sciences in the Integrated Marine Biosphere Research Project (IMBeR): Much Done, Much to Do?

Successful management and mitigation of marine challenges depends on cooperation and knowledge sharing which often occurs across culturally diverse geographic regions. Global ocean science collaboration is therefore essential for developing global solutions. Building effective global research networks that can enable collaboration also need to ensure inter- and transdisciplinary research approaches to tackle complex marine socio-ecological challenges. To understand the contribution of interdisciplinary global research networks to solving these complex challenges, we use the Integrated Marine Biosphere Research (IMBeR) project as a case study. We investigated the diversity and characteristics of 1,827 scientists from 11 global regions who were attendees at different IMBeR global science engagement opportunities since 2009. We also determined the role of social science engagement in natural science based regional programmes (using key informants) and identified the potential for enhanced collaboration in the future. Event attendees were predominantly from western Europe, North America, and East Asia. But overall, in the global network, there was growing participation by females, students and early career researchers, and social scientists, thus assisting in moving toward interdisciplinarity in IMBeR research. The mainly natural science oriented regional programmes showed mixed success in engaging and collaborating with social scientists. This was mostly attributed to the largely natural science (i.e., biological, physical) goals and agendas of the programmes, and the lack of institutional support and push to initiate connections with social science. Recognising that social science research may not be relevant to all the aims and activities of all regional programmes, all researchers however, recognised the (potential) benefits of interdisciplinarity, which included broadening scientists’ understanding and perspectives, developing connections and interlinkages, and making science more useful. Pathways to achieve progress in regional programmes fell into four groups: specific funding, events to come together, within-programme-reflections, and social science champions. Future research programmes should have a strategic plan to be truly interdisciplinary, engaging natural and social sciences, as well as aiding early career professionals to actively engage in such programmes.This publication resulted in part from support from the U.S. National Science Foundation (Grant OCE-1840868) to the Scientific Committee on Oceanic Research (SCOR)

HLA-DQA1*05 carriage associated with development of anti-drug antibodies to infliximab and adalimumab in patients with Crohn's Disease

Anti-tumor necrosis factor (anti-TNF) therapies are the most widely used biologic drugs for treating immune-mediated diseases, but repeated administration can induce the formation of anti-drug antibodies. The ability to identify patients at increased risk for development of anti-drug antibodies would facilitate selection of therapy and use of preventative strategies.This article is freely available via Open Access. Click on Publisher URL to access the full-text

Supplement use during an intergroup clinical trial for breast cancer (S0221)

The use of supplements during chemotherapy is controversial, partly due to the potential effect of antioxidants on reduced efficacy of chemotherapy-related cytotoxicity. We examined supplement use among breast cancer patients registered to a clinical trial (SWOG 0221) before diagnosis and during treatment. Patients (n = 1,467) completed questionnaires regarding multivitamin and supplement use at trial registration (baseline) to capture use before diagnosis. Of these patients, 1,249 completed a 6-month followup questionnaire to capture use during treatment. We examined the use of vitamins C, D, E, B6, B12, folic acid, and calcium at these timepoints, as well as physician recommendations regarding supplement use. The use of vitamins C, E, folic acid, and calcium decreased during treatment, while the use of vitamin B6 increased. Five hundred seventy four patients (51 %) received no physician recommendations regarding supplement use. Among the remaining 49, 10 % were advised not to take multivitamins and/or supplements, 7 % were advised to use only multivitamins, and 32 % received recommendations to use multivitamins and/or supplements. Among patients who took vitamin C before diagnosis, those who were advised not to take supplements were >5 times more likely not to use of vitamin C during treatment than those not advised to stop use (OR = 5.27, 95 % CI 1.13–24.6). Previous non-users who were advised to take a multivitamin were nearly 5 times more likely to use multivitamins during treatment compared to those who received no recommendation (OR = 4.66, 95 % CI 2.10–10.3). In this clinical trial for high-risk breast cancer, supplement use generally decreased during treatment. Upon followup from the clinical trial, findings regarding supplement use and survival outcomes will better inform physician recommendations for patients on adjuvant chemotherapy

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Background: Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods: TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings: Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation: Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding: Cancer Research UK