Scheduling Recess Before Lunch: Perceptions of Washington State Public Elementary School Professionals

Recess Before Lunch (RBL) is a wellness strategy with a purpose of improving the overall health and behavior of school-aged children. While some studies have reported a variety of benefits and challenges by simply scheduling recess prior to the specified lunchtime, few have examined adequate strategies for successful implementation. This mixed-methods study asked elementary school principals and school food service directors within each K-5th grade public school throughout the state of Washington to participate in an online survey assessing their school’s experience using RBL. Schools were placed into three groups based on participants’ stage of RBL adoption: (1) currently using RBL, (2) previously used RBL, or (3) have never implemented RBL. Basic demographic information from each school was collected and matched to the survey responses. Participants from the online survey were asked to provide contact information of a school professional closely involved with the lunch services in their school to complete a semi-structured follow-up interview. Eighteen individuals, six in each of the three stages of RBL adoption, participated in a 10-15-minute phone interview to further investigate perceptions related to RBL. Roughly 75.8% of schools reported having some experience with RBL (N = 74). Benefits most often reported were associated with Nutrition & Food Waste, Behavior & Disruption and Scheduling, respectively; whereas the barriers included Scheduling & Staffing, Logistics, Nutrition & Food Waste and Behavior & Disruption, respectively. However, whether a school reported any benefits had no effect on its history of scheduling the program. A significant correlation was found between student enrollment and a school’s experience with RBL. Schools that never implemented RBL had smaller student enrollments (p \u3c 0.01) and were significantly more likely to report any barriers (p \u3c 0.01), whereas schools currently utilizing the program that had a higher student enrollment (p \u3c 0.05) when compared to all other schools. Telephone interviewees reported the significance of gaining support from all involved parties and encouraged finding solutions to challenges prior to implementing the program

The use of standardized patients for mock oral board exams in neurology: a pilot study

BACKGROUND: Mock oral board exams, fashioned after the live patient hour of the American Board of Psychiatry and Neurology exam, are commonly part of resident assessment during residency training. Exams using real patients selected from clinics or hospitals are not standardized and do not allow comparisons of resident performance across the residency program. We sought to create a standardized patient mock oral board exam that would allow comparison of residents' clinical performance. METHODS: Three cases were created and then used for this mock oral boards exercise utilizing trained standardized patients. Residents from the University of Cincinnati and Indiana University participated in the exam. Residents were scored by attending physician examiners who directly observed the encounter with the standardized patient. The standardized patient also assessed each resident. A post-test survey was administered to ascertain participant's satisfaction with the examination process. RESULTS: Resident scores were grouped within one standard deviation of the mean, with the exception of one resident who was also subjectively felt to "fail" the exam. In exams with two faculty "evaluators", scores were highly correlated. The survey showed satisfaction with the examination process in general. CONCLUSION: Standardized patients can be used for mock oral boards in the live patient format. Our initial experience with this examination process was positive. Further testing is needed to determine if this examination format is more reliable and valid than traditional methods of assessing resident competency

Expression of P. falciparum var Genes Involves Exchange of the Histone Variant H2A.Z at the Promoter

Plasmodium falciparum employs antigenic variation to evade the human immune response by switching the expression of different variant surface antigens encoded by the var gene family. Epigenetic mechanisms including histone modifications and sub-nuclear compartmentalization contribute to transcriptional regulation in the malaria parasite, in particular to control antigenic variation. Another mechanism of epigenetic control is the exchange of canonical histones with alternative variants to generate functionally specialized chromatin domains. Here we demonstrate that the alternative histone PfH2A.Z is associated with the epigenetic regulation of var genes. In many eukaryotic organisms the histone variant H2A.Z mediates an open chromatin structure at promoters and facilitates diverse levels of regulation, including transcriptional activation. Throughout the asexual, intraerythrocytic lifecycle of P. falciparum we found that the P. falciparum ortholog of H2A.Z (PfH2A.Z) colocalizes with histone modifications that are characteristic of transcriptionally-permissive euchromatin, but not with markers of heterochromatin. Consistent with this finding, antibodies to PfH2A.Z co-precipitate the permissive modification H3K4me3. By chromatin-immunoprecipitation we show that PfH2A.Z is enriched in nucleosomes around the transcription start site (TSS) in both transcriptionally active and silent stage-specific genes. In var genes, however, PfH2A.Z is enriched at the TSS only during active transcription in ring stage parasites. Thus, in contrast to other genes, temporal var gene regulation involves histone variant exchange at promoter nucleosomes. Sir2 histone deacetylases are important for var gene silencing and their yeast ortholog antagonises H2A.Z function in subtelomeric yeast genes. In immature P. falciparum parasites lacking Sir2A or Sir2B high var transcription levels correlate with enrichment of PfH2A.Z at the TSS. As Sir2A knock out parasites mature the var genes are silenced, but PfH2A.Z remains enriched at the TSS of var genes; in contrast, PfH2A.Z is lost from the TSS of de-repressed var genes in mature Sir2B knock out parasites. This result indicates that PfH2A.Z occupancy at the active var promoter is antagonized by PfSir2A during the intraerythrocytic life cycle. We conclude that PfH2A.Z contributes to the nucleosome architecture at promoters and is regulated dynamically in active var genes

Lung cancer mortality in towns near paper, pulp and board industries in Spain: a point source pollution study

<p>Abstract</p> <p>Background</p> <p>This study sought to ascertain whether there might be excess lung cancer mortality among the population residing in the vicinity of Spanish paper and board industries which report their emissions to the European Pollutant Emission Register (EPER).</p> <p>Methods</p> <p>This was an ecological study that modelled the Standardised Mortality Ratio (SMR) for lung cancer in 8073 Spanish towns over the period 1994–2003. Population exposure to industrial pollution was estimated on the basis of distance from town of residence to pollution source. An exploratory, near-versus-far analysis was conducted, using mixed Poisson regression models and an analysis of the effect of municipal proximity within a 50-kilometre radius of each of the 18 installations.</p> <p>Results</p> <p>Results varied for the different facilities. In two instances there was an increasing mortality gradient with proximity to the installation, though this was exclusively observed among men.</p> <p>Conclusion</p> <p>The study of cancer mortality in areas surrounding pollutant foci is a useful tool for environmental surveillance, and serves to highlight areas of interest susceptible to being investigated by ad hoc studies. Despite present limitations, recognition is therefore due to the advance represented by publication of the EPER and the study of pollutant foci.</p

Streamlining Digital Modeling and Building Information Modelling (BIM) Uses for the Oil and Gas Projects

The oil and gas industry is a technology-driven industry. Over the last two decades, it has heavily made use of digital modeling and associated technologies (DMAT) to enhance its commercial capability. Meanwhile, the Building Information Modelling (BIM) has grown at an exponential rate in the built environment sector. It is not only a digital representation of physical and functional characteristics of a facility, but it has also made an impact on the management processes of building project lifecycle. It is apparent that there are many similarities between BIM and DMAT usability in the aspect of physical modeling and functionality. The aim of this study is to streamline the usage of both DMAT and BIM whilst discovering valuable practices for performance improvement in the oil and gas projects. To achieve this, 28 BIM guidelines, 83 DMAT academic publications and 101 DMAT vendor case studies were selected for review. The findings uncover (a) 38 BIM uses; (b) 32 DMAT uses and; (c) 36 both DMAT and BIM uses. The synergy between DMAT and BIM uses would render insightful references into managing efficient oil and gas’s projects. It also helps project stakeholders to recognise future investment or potential development areas of BIM and DMAT uses in their projects

EAACI position paper on occupational rhinitis

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item

Strengthening routine immunization in Papua New Guinea: a cross-sectional provincial assessment of front-line services

BACKGROUND: Routine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health. Low routine coverage contributes to disease outbreaks such as measles and the polio that re-appeared in 2018. We report on an in-depth local assessment that aimed to document immunization service provision so as to review a new national strategy, and consider how routine immunization could be better strengthened. METHODS: In East New Britain Province, over 2016 and 17, we carried out a cross-sectional assessment of 12 rural health facilities, staff and clients. The study was timed to follow implementation of a new national strategy for strengthening routine immunization. We used interview, structured observation, and records review, informed by theory-based evaluation, a World Health Organization quality checklist, and other health services research tools. RESULTS: We documented strengths and weaknesses across six categories of program performance relevant to national immunization strategy and global standards. We found an immunization service with an operational level of staff, equipment and procedures in place; but one that could reach only half to two thirds of its target population. Stronger routine services require improvement in: understanding of population catchments, tracking the unvaccinated, reach and efficiency of outreach visits, staff knowledge of vaccination at birth and beyond the first year of life, handling of multi-dose vials, and engagement of community members. Many local suggestions to enhance national plans, included more reliable on-demand services, integration of other family health services and increased involvement of men. CONCLUSIONS: The national strategy addresses most local gaps, but implementation and resourcing requires greater commitment. Long-term strengthening requires a major increase in centrally-allocated resources, however there are immediate locally feasible steps within current resources that could boost coverage and quality of routine immunization especially through better population-based local planning, and stronger community engagement. Our results also suggest areas where vaccination campaigns in PNG can contribute to routine immunization services

Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study

Background: Simulation has been identified as a means of assessing resident physicians’ mastery of technical skills, but there is a lack of evidence for its utility in longitudinal assessments of residents’ non-technical clinical abilities. We evaluated the growth of crisis resource management (CRM) skills in the simulation setting using a validated tool, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). We hypothesized that the Ottawa GRS would reflect progressive growth of CRM ability throughout residency. Methods: Forty-five emergency medicine residents were tracked with annual simulation assessments between 2006 and 2011. We used mixed-methods repeated-measures regression analyses to evaluate elements of the Ottawa GRS by level of training to predict performance growth throughout a 3-year residency. Results: Ottawa GRS scores increased over time, and the domains of leadership, problem solving, and resource utilization, in particular, were predictive of overall performance. There was a significant gain in all Ottawa GRS components between postgraduate years 1 and 2, but no significant difference in GRS performance between years 2 and 3. Conclusions: In summary, CRM skills are progressive abilities, and simulation is a useful modality for tracking their development. Modification of this tool may be needed to assess advanced learners’ gains in performance