Kids Don’t Float…and Their Parents Don’t Either: Using a Family-Centered Approach in Alaska’s Kids Don’t Float Program

The goal of this experiential report is to outline the adoption of a family-centered Kids Don’t Float approach. We conducted a critical synthesis of information to reflect the expansion of the Kids Don’t Float program into a more family-centered approach. The critical synthesis provided insights into why we should adopt this approach, how it was implemented, and how it influenced drowning incidents compared to the previously used child-centered approach. The adoption of a family-centered approach may contribute to reducing drowning incidents by targeting parents, providing safety information to families, and promoting parental modelling of life jackets. Program evaluators and water safety advocates may use these insights to strengthen injury prevention programs that target drowning incidents

Adaptation to Aquatic Risks due to Climate Change in Pangnirtung, Nunavut

We use a vulnerability framework to examine how residents of Pangnirtung, Nunavut, perceive the risks of aquatic activities in the context of adaptation to a changing climate. Our findings suggest that community members identify climate change as increasing the risk of many aquatic activities and have adapted some practices accordingly. However, further adaptation to these changing risks is impeded by three main barriers: (1) financial constraints, (2) Inuit resistance to adopting what some consider Euro-Canadian water safety practices, and (3) issues with the design of flotation devices. Participants suggested the following practical changes: (1) make personal flotation devices, lifejackets, and floater suits available to all residents at local stores at a subsidized rate, or provide them free of charge through the community; (2) create water safety promotional items that feature locally developed messages in both Inuktitut and English; (3) include traditional knowledge in water safety campaigns; and (4) use the local pool to train residents in water safety. These changes would not only help residents adapt to changing risks, but also help incorporate climate considerations into policies and programs.Nous utilisons un cadre de vulnérabilité pour examiner comment les habitants de Pangnirtung, au Nunavut, perçoivent les risques inhérents aux activités aquatiques dans le contexte de l’adaptation au changement climatique. Cette étude nous a permis de constater que les membres de la collectivité estiment que le changement climatique augmente le risque de nombreuses activités aquatiques et qu’ils ont modifié certaines de leurs manières de faire en conséquence. Cependant, trois grands obstacles entravent une adaptation plus poussée de ces risques : 1) les contraintes financières, 2) la résistance des Inuits à adopter ce que certains considèrent comme des méthodes eurocanadiennes plus sécuritaires, et 3) des problèmes de conception des appareils de flottaison. Les participants ont suggéré les changements pratiques suivants : 1) faire en sorte que des dispositifs de flottaison personnels, des gilets de sauvetage et des survêtements protecteurs soient à la disposition de tous les résidents à des prix subventionnés aux magasins de la région ou encore, qu’ils soient distribués aux gens gratuitement;2) créer du matériel promotionnel élaboré localement, en anglais et en inuktitut, pour promouvoir la sécurité sur l’eau; 3) faire en sorte que des connaissances traditionnelles soient intégrées aux campagnes relatives à la sécurité sur l’eau; et 4) montrer aux habitants de la région des techniques de sécurité sur l’eau à la piscine locale. Ces initiatives aideront non seulement les résidents à s’adapter aux risques changeants, mais également à tenir compte des considérations climatiques dans le cadre de leurs programmes et politiques

Impact of noncardiac findings in patients undergoing CT coronary angiography:a substudy of the Scottish computed tomography of the heart (SCOT-HEART) trial

Objectives Noncardiac findings are common on coronary computed tomography angiography (CCTA). We assessed the clinical impact of noncardiac findings, and potential changes to surveillance scans with the application of new lung nodule guidelines. Methods This substudy of the SCOT-HEART randomized controlled trial assessed noncardiac findings identified on CCTA. Clinically significant noncardiac findings were those causing symptoms or requiring further investigation, follow-up or treatment. Lung nodule follow-up was undertaken following the 2005 Fleischner guidelines. The potential impact of the 2015 British Thoracic Society (BTS) and the 2017 Fleischner guidelines was assessed. Results CCTA was performed in 1,778 patients and noncardiac findings were identified in 677 (38%). In 173 patients (10%) the abnormal findings were clinically significant and in 55 patients (3%) the findings were the cause of symptoms. Follow-up imaging was recommended in 136 patients (7.6%) and additional clinic consultations were organized in 46 patients (2.6%). Malignancy was diagnosed in 7 patients (0.4%). Application of the new lung nodule guidelines would have reduced the number of patients undergoing a follow-up CT scan: 68 fewer with the 2015 BTS guidelines and 78 fewer with the 2017 Fleischner guidelines; none of these patients subsequently developed malignancy. Conclusions Clinically significant noncardiac findings are identified in 10% of patients undergoing CCTA. Application of new lung nodule guidelines will reduce the cost of surveillance, without the risk of missing malignancy

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations

Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)

Occupational exposure to extremely low-frequency magnetic fields and follicular lymphoma risk: a family case–control study

Objectives: We aimed to examine the relationship between occupational exposure to extremely low-frequency magnetic fields (ELF-MFs) and follicular lymphoma (FL) risk. Methods: We conducted a family case–control study between 2011 and 2016 in Australia and included 681 cases. Controls were either a family member of cases (related (n=294), unrelated (n=179)) or were unrelated recruited for a similarly designed Australian multiple myeloma study (n=711). We obtained detailed job histories using lifetime work calendars. We assigned exposure to ELF-MFs using an enhanced job exposure matrix, with a lag period of 10 years. We examined associations with FL risk using logistic regression accounting for relatedness between cases and controls. We performed sensitivity analyses including by control type, by sex, complete case analyses, ELF-MF exposure percentiles in addition to quartiles, ELF-MF exposure in the maximum exposed job, a shorter lag period (1 year) and the cumulative exposure in the most recent time period (1–9 years). We observed no association with the average intensity, duration or lifetime cumulative exposure to occupational ELF-MF exposure in the primary or sensitivity analyses. Conclusions: Our findings do not support an association between occupational ELF-MF exposure and FL risk. Although the inclusion of family members as part of the larger control group may have biased our risk estimates towards the null, findings were similar in sensitivity analyses restricted to cases and unrelated controls. Further research incorporating enhanced exposure assessment to ELF-MF is warranted to inform occupational safety regulations and any potential role in lymphomagenesis

Active restoration accelerates the carbon recovery of human modified-tropical forests

More than half of all tropical forests are degraded by human impacts, leaving them threatened with conversion to agricultural plantations and risking substantial biodiversity and carbon losses. Restoration could accelerate recovery of aboveground carbon density (ACD), but adoption of restoration is constrained by cost and uncertainties over effectiveness. We report a long-term comparison of ACD recovery rates between naturally regenerating and actively restored logged tropical forests. Restoration enhanced decadal ACD recovery by more than 50%, from 2.9 to 4.4 megagrams per hectare per year. This magnitude of response, coupled with modal values of restoration costs globally, would require higher carbon prices to justify investment in restoration. However, carbon prices required to fulfill the 2016 Paris climate agreement [$40 to$80 (USD) per tonne carbon dioxide equivalent] would provide an economic justification for tropical forest restoration

Fine-mapping identifies multiple prostate cancer risk loci at 5p15, one of which associates with TERT expression

Associations between single nucleotide polymorphisms (SNPs) at 5p15 and multiple cancer types have been reported. We have previously shown evidence for a strong association between prostate cancer (PrCa) risk and rs2242652 at 5p15, intronic in the telomerase reverse transcriptase (TERT) gene that encodes TERT. To comprehensively evaluate the association between genetic variation across this region and PrCa, we performed a fine-mapping analysis by genotyping 134 SNPs using a custom Illumina iSelect array or Sequenom MassArray iPlex, followed by imputation of 1094 SNPs in 22 301 PrCa cases and 22 320 controls in The PRACTICAL consortium. Multiple stepwise logistic regression analysis identified four signals in the promoter or intronic regions of TERT that independently associated with PrCa risk. Gene expression analysis of normal prostate tissue showed evidence that SNPs within one of these regions also associated with TERT expression, providing a potential mechanism for predisposition to disease