Age-related gait standards for healthy children and young people: the GOS-ICH paediatric gait centiles

Objective To develop paediatric gait standards in healthy children and young people. Methods This observational study builds on earlier work to address the lack of population standards for gait measurements in children. Analysing gait in children affected by neurological or musculoskeletal conditions is an important component of paediatric assessment but is often confounded by developmental changes. The standards presented here do not require clinician expertise to interpret and offer an alternative to developmental tables of normalised gait data. Healthy children aged 1-19 years were recruited from community settings in London and Hertfordshire, U.K. The GAITRite ® walkway was used to record measurements for each child for velocity, cadence, step length, base of support, and stance, single and double support (as percentage of gait cycle). We fitted generalized linear additive models for location, scale and shape (gamlss). Results We constructed percentile charts for seven gait variables measured on 624 (321 males) contemporary healthy children using gamlss package in R. A clinical application of gait standards was explored. Conclusion Age-related, gender-specific standards for seven gait variables were developed and are presented here. They have a familiar format and can be used clinically to aid diagnoses, and to monitor change over time for both medical therapy and natural history of the condition. The clinical example demonstrates the potential of the GOS-ICH Paediatric Gait Centiles (GOS-ICH PGC) to enable meaningful interpretation of change in an individual’s performance, and describes characteristic features of gait from a specific population throughout childhood.Peer reviewedFinal Accepted Versio

Medical student wellbeing - a consensus statement from Australia and New Zealand

Abstract Background Medical student wellbeing – a consensus statement from Australia and New Zealand outlines recommendations for optimising medical student wellbeing within medical schools in our region. Worldwide, medical schools have responsibilities to respond to concerns about student psychological, social and physical wellbeing, but guidance for medical schools is limited. To address this gap, this statement clarifies key concepts and issues related to wellbeing and provides recommendations for educational program design to promote both learning and student wellbeing. The recommendations focus on student selection; learning, teaching and assessment; learning environment; and staff development. Examples of educational initiatives from the evidence-base are provided, emphasising proactive and preventive approaches to student wellbeing. Main recommendations The consensus statement provides specific recommendations for medical schools to consider at all stages of program design and implementation. These are:Design curricula that promote peer support and progressive levels of challenge to students.Employ strategies to promote positive outcomes from stress and to help others in need.Design assessment tasks to foster wellbeing as well as learning.Provide mental health promotion and suicide prevention initiatives.Provide physical health promotion initiatives.Ensure safe and health-promoting cultures for learning in on-campus and clinical settings.Train staff on student wellbeing and how to manage wellbeing concerns. Conclusion A broad integrated approach to improving student wellbeing within medical school programs is recommended. Medical schools should work cooperatively with student and trainee groups, and partner with clinical services and other training bodies to foster safe practices and cultures. Initiatives should aim to assist students to develop adaptive responses to stressful situations so that graduates are prepared for the realities of the workplace. Multi-institutional, longitudinal collaborative research in Australia and New Zealand is needed to close critical gaps in the evidence needed by medical schools in our region

Digital mammography: current view and future applications

In digital mammography, imaging acquisition, display and storage processes are separated and individually optimized. Radiation transmitted through the breast is absorbed by an electronic detector with an accurate response over a wide range of intensities. Once these data are stored, they can be displayed by means of computer image-processing techniques to allow arbitrary settings of image brightness, contrast and magnification, without the need for further radiological exposure of the patient. In this article, the current state of the art in technology for digital mammography and clinical trials data supporting the use of this technology are reviewed. In addition, several potentially useful applications, currently under development with digital mammography, are described.Na mamografia digital, os processos de aquisição da imagem, demonstração e armazenamento são separados, o que leva à otimização de cada uma dessas etapas. A radiação transmitida através da mama é absorvida por um detector eletrônico, em resposta fiel a uma ampla variedade de intensidades. Uma vez que esta informação é armazenada, ela pode ser demonstrada usando técnicas computadorizadas de imagem, permitindo variações de brilho e contraste e ampliação, sem a necessidade de exposições radiológicas adicionais para a paciente. Neste artigo, o estado atual da tecnologia em mamografia digital e dados sobre testes clínicos que dão suporte ao uso dessa tecnologia são revistos. Além disso, algumas aplicações potencialmente utilizáveis que estão sendo desenvolvidas com a mamografia digital são descritas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemColégio Brasileiro de Radiologia e Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GinecologiaUNIFESP, EPM, Depto. de Diagnóstico por ImagemUNIFESP, EPM, Depto. de GinecologiaSciEL

Skeletal muscle ACC2 S212 phosphorylation is not required for the control of fatty acid oxidation during exercise

During submaximal exercise fatty acids are a predominant energy source for muscle contractions. An important regulator of fatty acid oxidation is acetyl‐CoA carboxylase (ACC), which exists as two isoforms (ACC1 and ACC2) with ACC2 predominating in skeletal muscle. Both ACC isoforms regulate malonyl‐CoA production, an allosteric inhibitor of carnitine palmitoyltransferase 1 (CPT‐1); the primary enzyme controlling fatty acyl‐CoA flux into mitochondria for oxidation. AMP‐activated protein kinase (AMPK) is a sensor of cellular energy status that is activated during exercise or by pharmacological agents such as metformin and AICAR. In resting muscle the activation of AMPK with AICAR leads to increased phosphorylation of ACC (S79 on ACC1 and S221 on ACC2), which reduces ACC activity and malonyl‐CoA; effects associated with increased fatty acid oxidation. However, whether this pathway is vital for regulating skeletal muscle fatty acid oxidation during conditions of increased metabolic flux such as exercise/muscle contractions remains unknown. To examine this we characterized mice lacking AMPK phosphorylation sites on ACC2 (S212 in mice/S221 in humans‐ACC2‐knock‐in [ACC2‐KI]) or both ACC1 (S79) and ACC2 (S212) (ACC double knock‐in [ACCD‐KI]) during submaximal treadmill exercise and/or ex vivo muscle contractions. We find that surprisingly, ACC2‐KI mice had normal exercise capacity and whole‐body fatty acid oxidation during treadmill running despite elevated muscle ACC2 activity and malonyl‐CoA. Similar results were observed in ACCD‐KI mice. Fatty acid oxidation was also maintained in muscles from ACC2‐KI mice contracted ex vivo. These findings indicate that pathways independent of ACC phosphorylation are important for regulating skeletal muscle fatty acid oxidation during exercise/muscle contractions

Ghrelin-AMPK Signaling Mediates the Neuroprotective Effects of Calorie Restriction in Parkinson's Disease

Jacqeline Bayliss, Romana Stark, Moyra Lemus, Vanessa Santos, Aiysha Thompson, Daniel Rees, Sandra Galic, John Elsworth, Bruce Kemp, Jeffrey Davies, and Zane Andrew

Greenstone burial–exhumation cycles at the late Archean transition to plate tectonics

Converging lines of evidence suggest that, during the late Archean, Earth completed its transition from a stagnant-lid to a plate tectonics regime,although how and when this transition occurred is debated. The geological record indicates that some form of subduction, a key component of plate tectonics—has operated since the Mesoarchean, even though the tectonic style and timescales of burial and exhumation cycles within ancient convergent margins are poorly constrained.Here, we present a Neoarchean pressure–temperature–time (P–T–t) path from supracrustal rocks of the transpressional Yilgarn orogen (Western Australia), which documents how sea-floor-altered rocks underwent deep burial then exhumation during shortening that was unrelated to the episode of burial. Archean subduction, even if generally short-lived, was capable of producing eclogites along converging lithosphere boundaries, although exhumation processes in those environments were likely less efficient than today, such that return of high-pressure rocks to the surface was rare

Expressions 1987

https://openspace.dmacc.edu/expressions/1030/thumbnail.jp

Juvenile crust formation in the Zimbabwe Craton deduced from the O-Hf isotopic record of 3.8–3.1 Ga detrital zircons

Hafnium and oxygen isotopic compositions measured in-situ on U-Pb dated zircon from Archaean sedimentary successions belonging to the 2.9-2.8 Ga Belingwean/Bulawayan groups and previously undated Sebakwian Group are used to characterize the crustal evolution of the Zimbabwe Craton prior to 3.0 Ga. Microstructural and compositional criteria were used to minimize effects arising from Pb loss due to metamorphic overprinting and interaction with low-temperature fluids. 207 Pb/206 Pb age spectra (concordance >90%) reveal prominent peaks at 3.8, 3.6, 3.5, and 3.35 Ga, corresponding to documented geological events, both globally and within the Zimbabwe Craton. Zircon delta O-18 values from +4 to +10% point to both derivation from magmas in equilibrium with mantle oxygen and the incorporation of material that had previously interacted with water in near-surface environments. In epsilon(Hf)-time space, 3.8-3.6 Ga grains define an array consistent with reworking of a mafic reservoir ((176) Lu/(177) Hf similar to 0.015) that separated from chondritic mantle at similar to 3.9 Ga. Crustal domains formed after 3.6 Ga depict a more complex evolution, involving contribution from chondritic mantle sources and, to a lesser extent, reworking of pre-existing crust. Protracted remelting was not accompanied by significant mantle depletion prior to 3.35 Ga. This implies that early crust production in the Zimbabwe Craton did not cause complementary enriched and depleted reservoirs that were tapped by later magmas, possibly because the volume of crust extracted and stabilised was too small to influence (asthenospheric) mantle isotopic evolution. Growth of continental crust through pulsed emplacement of juvenile (chondritic mantle-derived) melts, into and onto the existing cratonic nucleus, however, involved formation of complementary depleted subcontinental lithospheric mantle since the early Archaean, indicative of strongly coupled evolutionary histories of both reservoirs, with limited evidence for recycling and lateral accretion of arc-related crustal blocks until 3.35 Ga. (C) 2017 Elsevier Ltd. All rights reserved