Failing boys and moral panics: perspectives on the underachievement debate

The paper re-examines the underachievement debate from the perspective of the ‘discourse of derision’ that surrounds much writing in this area. It considers the contradictions and inconsistencies which underpin much of the discourse – from a reinterpretation of examination scores, to the conflation of the concepts of ‘under’ and ‘low’ achievement and finally to the lack of consensus on a means of defining and measuring the term underachievement. In doing so, this paper suggests a more innovative approach for understanding, re-evaluating and perhaps rejecting the notion of underachievement

Serum levels of hydroxylated metabolites of arachidonic acid cross-sectionally and longitudinally predict knee pain progression: an observational cohort study

Objective: To examine associations between serum oxylipins, which regulate tissue repair and pain signalling, and knee pain/radiographic osteoarthritis (OA) at baseline and knee pain at 3 year follow-up.Method: Baseline, and 3 year follow-up, knee pain phenotypes were assessed from 154 participants in the Knee Pain in the Community Cohort (KPIC) study. Serum and radiographic Kellgren and Lawrence (KL) and Nottingham line drawing atlas (NLDA) OA scores were collected at baseline. Oxylipin levels were quantified using liquid chromatography coupled with mass spectrometry (LC-MS/MS). Associations were measured by linear regression and Receiver Operator Characteristics (ROC).Results: Serum levels of 8,9-epoxyeicosatrienoic acid (EET) (β(95%CI)=1.809(-0.71-2.91)), 14,15-dihydroxyeicosatrienoic acid (DHET) (β(95%CI)=0.827(0.34-1.31)), and 12-hydroxyeicosatetraenoic acid (β(95%CI)=4.090(1.92-6.26)) and anandamide (β(95%CI)=3.060(1.35-4.77)) were cross-sectionally associated with current self-reported knee pain scores (NRS item 3, average pain). Serum levels of 9- (β(95%CI)=0.467(0.18-0.75)) & 15-hydroxyeicosatetraenoic acid (β(95%CI)=0.759(0.29-1.22)), 14-hydroxydocosahexaenoic acid (β(95%CI)=0.483(0.24-0.73)), and the ratio of 8,9-EET:DHET (β(95%CI)=0.510(0.19-0.82)) were cross-sectionally associated with K/L scores. Baseline serum concentrations of 8,9-EET (β(95%CI)=2.166(0.89-3.44)), 5,6-DHET (β(95%CI)=152.179(69.39-234.97)), and 5-HETE (β(95%CI)=1.724(0.677-2.77) showed positive longitudinal associations with follow-up knee pain scores (NRS item 3, average pain). Combined serum 8,9-EET and 5-HETE concentration showed the strongest longitudinal association (β(95%CI)=1.156(0.54-1.77) with pain scores at 3 years, and ROC curves distinguished between participants with no pain and high pain scores at follow-up (AUC(95%CI)=0.71(0.61-0.82)).Conclusions: Serum levels of a combination of hydroxylated metabolites of arachidonic acid may have prognostic utility for knee pain, providing a potential novel approach to identify people who are more likely to have debilitating pain in the future.Keywords: arachidonic acid; biomarkers; knee pain; osteoarthritis; oxylipins

Safety and efficacy of diaphragm pacing in patients with respiratory insufficiency due to amyotrophic lateral sclerosis (DiPALS): a multicentre, open-label, randomised controlled trial

Background: Non-invasive ventilation is part of the standard of care for treatment of respiratory failure in patients with amyotrophic lateral sclerosis (ALS). The NeuRx RA/4 Diaphragm Pacing System has received Humanitarian Device Exemption approval from the US Food and Drug Administration for treatment of respiratory failure in patients with ALS. We aimed to establish the safety and efficacy of diaphragm pacing with this system in patients with respiratory muscle weakness due to ALS. Methods: We undertook a multicentre, open-label, randomised controlled trial at seven specialist ALS and respiratory centres in the UK. Eligible participants were aged 18 years or older with laboratory supported probable, clinically probable, or clinically definite ALS; stable riluzole treatment for at least 30 days; and respiratory insufficiency. We randomly assigned participants (1:1), via a centralised web-based randomisation system with minimisation that balanced patients for age, sex, forced vital capacity, and bulbar function, to receive either non-invasive ventilation plus pacing with the NeuRx RA/4 Diaphragm Pacing System or non-invasive ventilation alone. Patients, carers, and outcome assessors were not masked to treatment allocation. The primary outcome was overall survival, defined as the time from randomisation to death from any cause. Analysis was by intention to treat. This trial is registered, ISRCTN number 53817913. Findings: Between Dec 5, 2011, and Dec 18, 2013, we randomly assigned 74 participants to receive either non-invasive ventilation alone (n=37) or non-invasive ventilation plus diaphragm pacing (n=37). On Dec 18, 2013, the Data Monitoring and Ethics Committee (DMEC) recommended suspension of recruitment on the basis of overall survival figures. Randomly assigned participants continued as per the study protocol until June 23, 2014, when the DMEC advised discontinuation of pacing in all patients. Follow-up assessments continued until the planned end of the study in December, 2014. Survival was shorter in the non-invasive ventilation plus pacing group than in the non-invasive ventilation alone group (median 11·0 months [95% CI 8·3-13·6] vs 22·5 months [13·6-not reached]; adjusted hazard ratio 2·27, 95% CI 1·22-4·25; p=0·009). 28 (76%) patients died in the pacing group and 19 (51%) patients died in the non-invasive ventilation alone group. We recorded 162 adverse events (5·9 events per person-year) in the pacing group, of which 46 events were serious, compared with 81 events (2·5 events per person-year) in the non-invasive ventilation alone group, of which 31 events were serious. Interpretation: Addition of diaphragm pacing to standard care with non-invasive ventilation was associated with decreased survival in patients with ALS. Our results suggest that diaphragmatic pacing should not be used as a routine treatment for patients with ALS in respiratory failure

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

The design and development of oligonucleotide probes for the identification of streptococci that cause mastitis

SIGLEAvailable from British Library Document Supply Centre- DSC:DX178663 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Global oil peaking: responding to the case for 'abundant supplies of oil'

This paper examines aspects of the case against global oil peaking, and in particular sets out to answer a viewpoint that the world can have abundant supplies of oil "for years to come". Arguments supporting the latter view include: past forecasts of oil shortage have proved incorrect, so current predictions should also be discounted; many modellers depend on Hubbert's analysis but this contained fundamental flaws; new oil supply will result from reserves growth and from the wider deployment of advanced extraction technology; and that the world contains large resources of unconventional oil that can come on-stream if the production of conventional oil declines. These arguments are examined in turn and shown to be incorrect, or to need setting into a broader context. The paper concludes therefore that such arguments cannot be used to rule out calculations that the resource-limited peak in the world's production of conventional oil will occur in the near term. Moreover, peaking of conventional oil is likely to impact the world's total availability of oil where the latter includes non-conventional oil and oil substitutes. (C) 2008 Elsevier Ltd. All rights reserved