Interventions for autumn exacerbations of asthma in children

Background Asthma exacerbations in school-aged children peak in autumn, shortly after children return to school following the summer holiday. This might reflect a combination of risk factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. Since this peak is predictable, interventions targeting modifiable risk factors might reduce exacerbation-associated morbidity and strain upon health resources. The peak occurs in September in theNorthernHemisphere and in February in the Southern Hemisphere. Objectives To assess the effects of pharmacotherapy and behavioural interventions enacted in anticipation of school return during autumn that are designed to reduce asthma exacerbations in children during this period. Search methods We searched the Cochrane Airways Group Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, reference lists of primary studies and existing reviews, and manufacturers' trial registries (Merck, Novartis and Ono Parmaceuticals). We searched databases from their inception to 1 December 2017, and imposed no restriction on language of publication. Selection criteria We included all randomised controlled trials comparing interventions aimed specifically at reducing autumn exacerbations with usual care, (no systematic change in management in preparation for school return). We included studies providing data on children aged 18 years or younger. Data collection and analysis We used standard methodological procedures expected by Cochrane. Two review authors independently screened records identified by the search and then extracted data and assessed bias for trials meeting the inclusion criteria. A third review author checked for accuracy and mediated consensus on disagreements. The primary outcome was proportion of children experiencing one ormore asthma exacerbations requiring hospitalisation or oral corticosteroids during the autumn period.</p

Validating an Instrument to Measure Students' Attitude Towards Smart Schools

Iranian educational systems heavily focus  on Smart schools and equipping. Based on social-cognitive theory student attitude toward school affect student achievement and motivation. With attention to the importance of student attitude toward technology and schools, this study aims to develop and validate a questionnaire in order to estimate student attitude toward Smart schools. A sample 305 middle school student from grade 7 and 8 in South Khorasan   was selected randomly. Exploratory factor analysis identified 9 factors that explain 62 present of the variance of student attitude toward smart schools. These factors include: attitude towards interactive whiteboard; attitude towards teacher;  reluctance to classroom; general attitude towards smart schools; test and feedback; feeling alone in school; student satisfaction from teaching; the impression of school and finally family attitude. The alpha value revealed instrument is reliable (α=0. 89). All Instrument factors can predict 22.5 percent of the variance of students' self-expressed GPA. This questionnaire was recommended to researchers to study and school policy makers for decision making

Interventions for autumn exacerbations of asthma in children

Background Asthma exacerbations in school-aged children peak in autumn, shortly after children return to school following the summer holiday. This might reflect a combination of risk factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. Since this peak is predictable, interventions targeting modifiable risk factors might reduce exacerbation-associated morbidity and strain upon health resources. The peak occurs in September in the Northern Hemisphere and in February in the Southern Hemisphere. Objectives To assess the effects of pharmacotherapy and behavioural interventions enacted in anticipation of school return during autumn that are designed to reduce asthma exacerbations in children during this period. Search methods We searched the Cochrane Airways Group Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, reference lists of primary studies and existing reviews, and manufacturers’ trial registries (Merck, Novartis and Ono Parmaceuticals). We searched databases from their inception to 1 December 2017, and imposed no restriction on language of publication. Selection criteria We included all randomised controlled trials comparing interventions aimed specifically at reducing autumn exacerbations with usual care, (no systematic change in management in preparation for school return). We included studies providing data on children aged 18 years or younger. Data collection and analysis We used standard methodological procedures expected by Cochrane. Two review authors independently screened records identified by the search and then extracted data and assessed bias for trials meeting the inclusion criteria. A third review author checked for accuracy and mediated consensus on disagreements. The primary outcome was proportion of children experiencing one or more asthma exacerbations requiring hospitalisation or oral corticosteroids during the autumn period. Main results Our searches returned 546 trials, of which five met our inclusion criteria. These studies randomised 14,252 children to receive either an intervention or usual care. All studies were conducted in the Northern Hemisphere. Three interventions used a leukotriene receptor antagonist, one used omalizumab or a boost of inhaled corticosteroids, and the largest study, (12,179 children), used a medication reminder letter. Whilst the risk of bias within individual studies was generally low, we downgraded the evidence quality due to imprecision associated with low participant numbers, poor consistency between studies, and indirect outcome ascertainment. A US study of 513 children with mild/severe asthma and allergic sensitisation was the only study to provide data for our primary outcome. In this study, the proportion of participants experiencing an exacerbation requiring oral corticosteroids or hospital admission in the 90 days after school return was significantly reduced to 11.3% in those receiving omalizumab compared to 21.0% in those receiving placebo (odds ratio 0.48, 95% confidence interval 0.25 to 0.92, moderate-quality evidence). The remaining studies used alternative exacerbation definitions. When data from two leukotriene receptor antagonist studies with comparable outcomes were combined in a random-effects model, there was no evidence of an effect upon exacerbations. There was no evidence that a seasonal medication reminder letter decreased unscheduled contacts for a respiratory diagnosis between September and December. Four studies recorded adverse events. There was no evidence that the proportion of participants experiencing at least one adverse event differed between intervention and usual care groups. Lack of data prevented planned subgroup and sensitivity analyses. Authors' conclusions Seasonal omalizumab treatment from four to six weeks before school return might reduce autumn asthma exacerbations. We found no evidence that this strategy is associated with increased adverse effects other than injection site pain, but it is costly. There were no data upon which to judge the effect of this or other seasonal interventions on asthma control, quality of life, or asthma-related death. In future studies definitions of exacerbations should be provided, and standardised where possible. To investigate possible differential effects according to subgroup, participants in future trials should be well characterised with respect to baseline asthma severity and exacerbation history in addition to age and gender

A 4-week biodex stability exercise program improved ankle musculature onset, peak latency and balance measures in functionally unstable ankles

Objectives: The purpose of this study was to examine the effects of Biodex stability training on the onset of muscle activity and balance measures in participants with functional ankle instability (FAI). Materials and methods: The musculature onset and peak latency of the peroneals, tibialis anterior and soleus of 15 patients with FAI were recorded with surface electromyography (EMG) in response to sudden 10°, 20° and 30° inversions by an Ankle Perturbation System (APS), both before and after stability training. Participants underwent a monitored 4-week Biodex stability program (12 min per session, three times a week). Pre-and post-training balance measures were also recorded by the Biodex Stability System. Design: Quasi-experimental. Results: Post-training, there was a significant decrease in muscle onset and peak latency (p<0.05) for the peroneals and tibialis anterior, and a significant improvement in balance measures (p<0.001). Conclusion: Based on the present results, a Biodex stability exercise program may be recommended for the rehabilitation of FAI. © 2007 Elsevier Ltd. All rights reserved

Evaluation of Biological Activity and Analysis of Volatile Fraction from Pterocarya fraxinifolia in Vegetative Stage from Iran

This study reports chemical composition of the essential oils and in vitro antioxidant, antimicrobial and cytotoxic activity of the volatile fraction, extracted using simulations steam distillation-solvent extraction (SDE) method, and methanolic extract from the stems and young leaves of Pterocarya fraxinifolia from Gilan, west-north of Iran for the first time. The extraction yield of volatile fraction from stems was about two times more than that of leaves. GC and GC/MS analysis of the stem oil, exhibited 44 components; the most abundant constituents was hexadecanoic acid. On the other hand,23 components were identified in the oil from leaves, with 3¸7-guaiadiene as the major components. The oils and extracts from both examined plant samples showed excellent antioxidant activities in 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay (IC50 values <45 µg/mL). In ß-carotene bleaching assay, only the extracts showed high activities with inhibition percentages more than 80%. Total phenolic contents, based on gallic acid equivalent, for the leaves and stems extracts were also very high. Screening of cytotoxic activity of the extracts via brine shrimp lethality assay exhibited higher activity for stem. About antimicrobial properties, each sample showed high activity against at least 1 tested microorganism. In comparison, stem extract and oil exhibited higher biological activities than that of leaves

The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review.

INTRODUCTION: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. METHODS: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. RESULTS: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. CONCLUSION: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.Funding: Dr Benjamin M. Davies is supported by an NIHR Clinical Doctoral Research Fellowship. This report is independent research arising from a Clinician Scientist Award, CS-2015-15-023, supported by the National Institute for Health Research

Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review

Background: An estimated 2.6 million newborns died in 2016; over 98.5% of deaths occurred in low- and middle-income countries (LMICs). Neonates born preterm and small for gestational age are particularly at risk given the high incidence of infectious complications, cardiopulmonary, and neurodevelopmental disorders in this group. Quality improvement (QI) initiatives can reduce the burden of mortality and morbidity for hospitalised newborns in these settings. We undertook a systematic review to synthesise evidence from LMICs on QI approaches used, outcome measures employed to estimate effects, and the nature of implementation challenges. Methods: We searched Medline, EMBASE, WHO Global Health Library, Cochrane Library, WHO ICTRP, and ClinicalTrials.gov and scanned the references of identified studies and systematic reviews. Searches covered January 2000 until April 2017. Search terms were “quality improvement”, “newborns”, “hospitalised”, and their derivatives. Studies were excluded if they took place in high-income countries, did not include QI interventions, or did not include small and sick hospitalised newborns. Cochrane Risk of Bias tools were used to quality appraise the studies. Results: From 8110 results, 28 studies were included, covering 23 LMICs and 65,642 participants. Most interventions were meso level (district and clinic level); fewer were micro (patient-provider level) or macro (above district level). In-service training was the most common intervention subtype; service organisation and distribution of referencing materials were also frequently identified. The most commonly assessed outcome was mortality, followed by length of admission, sepsis rates, and infection rates. Key barriers to implementation of quality improvement initiatives included overburdened staff and lack of sufficient equipment. Conclusions: The frequency of meso level, single centre, and educational interventions suggests that these interventions may be easier for programme planners to implement. The success of some interventions in reducing morbidity and mortality rates suggests that QI approaches have a high potential for benefit to newborns. Going forward, there are opportunities to strengthen the focus of QI initiatives and to develop improved, larger-scale, collaborative research into implementation of quality improvement initiatives for this high-risk group

Global Health Education in Medical Schools (GHEMS) study protocol

# Background Global health is the study, research, and practice of medicine focused on improving health and achieving health equity for all persons worldwide. Such focuses are core tenets of modern medical practice. The General Medical Council (GMC) have published several documents that outline specific global health learning outcomes and competencies that are essential, non-elective components of UK medical school curricula. However, there is a paucity of evidence demonstrating that medical schools have integrated these mandatory global health learning outcomes within their curricula. This multicentre study aims to delineate the breadth of global health teaching during undergraduate and graduate entry medical training across UK medical schools. # Methods This national, multi-centre study will involve obtaining timetables containing details of all medical teaching provided at undergraduate and/or graduate entry level at UK medical schools for the academic year 2018/2019. Collaborators at each centre will independently code all timetabled global health learning events (compulsory, optional, or pre-elective), conforming to a pre-devised standard framework that will enable description of teaching events in terms of course year, duration, teaching format, and teaching content. The quantitative and qualitative data will be analysed using descriptive statistics and thematic analysis, respectively. Krippendorff's alpha coefficient will also be utilised to measure the level of agreement between datasets collected independently by different collaborators at the same centre. # Results This study will define, for the first time, the nature and characteristics of global health education within UK medical school curricula. It will capture any differences in the amount of teaching provided on various global health learning outcomes between medical schools. # Conclusions If this study depicts national discrepancies in teaching, it will place the onus on medical schools and the GMC to provide standardised and adequate global health education within the undergraduate and graduate entry medical curriculum. To aid medical schools in achieving this, the study will also identify currently scheduled teaching events at each medical school that could incorporate material related to the mandatory global health learning outcomes

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Anti-inflammatory and immune-modulatory impacts of berberine on activation of autoreactive T cells in autoimmune inflammation

Autoreactive inflammatory CD4+ T cells, such as T helper (Th)1 and Th17 subtypes, have been found to associate with the pathogenesis of autoimmune disorders. On the other hand, CD4+ Foxp3+ T regulatory (Treg) cells are crucial for the immune tolerance and have a critical role in the suppression of the excessive immune and inflammatory response promoted by these Th cells. In contrast, dendritic cells (DCs) and macrophages are immune cells that through their inflammatory functions promote autoreactive T-cell responses in autoimmune conditions. In recent years, there has been increasing attention to exploring effective immunomodulatory or anti-inflammatory agents from the herbal collection of traditional medicine. Berberine, an isoquinoline alkaloid, is one of the main active ingredients extracted from medicinal herbs and has been shown to exert various biological and pharmacological effects that are suggested to be mainly attributed to its anti-inflammatory and immunomodulatory properties. Several lines of experimental study have recently investigated the therapeutic potential of berberine for treating autoimmune conditions in animal models of human autoimmune diseases. Here, we aimed to seek mechanisms underlying immunomodulatory and anti-inflammatory effects of berberine on autoreactive inflammatory responses in autoimmune conditions. Reported data reveal that berberine can directly suppress functions and differentiation of pro-inflammatory Th1 and Th17 cells, and indirectly decrease Th cell-mediated inflammation through modulating or suppressing other cells assisting autoreactive inflammation, such as Tregs, DCs and macrophages. © 2020 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Lt