Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015

The third International Exercise-Associated Hyponatremia (EAH) Consensus Development Conference convened in Carlsbad, California in February 2015 with a panel of 17 international experts. The delegates represented 4 countries and 9 medical and scientific sub-specialties pertaining to athletic training, exercise physiology, sports medicine, water/sodium metabolism, and body fluid homeostasis. The primary goal of the panel was to review the existing data on EAH and update the 2008 Consensus Statement.1 This document serves to replace the second International EAH Consensus Development Conference Statement and launch an educational campaign designed to address the morbidity and mortality associated with a preventable and treatable fluid imbalance. The following statement is a summary of the data synthesized by the 2015 EAH Consensus Panel and represents an evolution of the most current knowledge on EAH. This document will summarize the most current information on the prevalence, etiology, diagnosis, treatment and prevention of EAH for medical personnel, athletes, athletic trainers, and the greater public. The EAH Consensus Panel strove to clearly articulate what we agreed upon, did not agree upon, and did not know, including minority viewpoints that were supported by clinical experience and experimental data. Further updates will be necessary to both: (1) remain current with our understanding and (2) critically assess the effectiveness of our present recommendations. Suggestions for future research and educational strategies to reduce the incidence and prevalence of EAH are provided at the end of the document as well as areas of controversy that remain in this topic. [excerpt

Tinklalaidės neformaliajame mokymesi: socialinių medijų naudojimas asmeninės mokymosi aplinkos, asmeninio mokymosi tinklo kūrimui

The use of second-generation web technology (WEB2) in education is emphasising the role of social media as educational sources. Researchers that are analysing personal learning environments (Schaffert, Kalz, 2009; Dabbagh, Kitsantas, 2012), personal learning networks (Couros, 2010) suggest the importance of social media, although this emphasis is attributed to the collaborative interaction of learners. To comprehensively assess the potential of podcasts as social media in the creation of personal learning environments, personal learning networks, the research described in this article does not restrict the definition of podcasts as the potential of collaboration provided by social media. In this article, attention is directed towards the potential of podcasts in the creation of personal learning environment and personal learning networks. By using integrated information behaviour module analysis to determine if the students of Lithuanian higher education institutions value the potential of informal learning provided by podcasts. To determine if these technologies are used for the formation of personal learning environments, personal learning networks, a discussion group research was conducted. During the research the analysis of participant podcast usage showed there is interaction between media content used for recreation and media content used for formal and informal learning. This means that the participants of the research use podcasts to create personal learning environments. On the other hand, this interaction is minimal, created only by the learners and reasoned by the search of educational podcasts. The analysis of the experiences of the discussion participants revealed that the collaborative interaction between learners involved in the research in searching, sharing and using podcasts in the process of learning is not intensive, it is typically fragmented. This allows to point out that the communities that use podcasts for informal learning are not forming. This shows that the potential of podcasts in creating a learning network is not fulfilled, and that podcasts don’t inspire participatory learning.Antrosios kartos saityno technologijų (WEB2) naudojimas mokymesi nurodo socialinių medijų kaip mokymosi šaltinių, išteklių reikšmės augimą. Šiame straipsnyje dėmesys atkreipiamas į tinklalaidžių potencialą besimokančiųjų asmeninės mokymosi aplinkos, asmeninio mokymosi tinklo kūrimui. Mokslininkai, analizuojantys asmeninę mokymosi aplinką (Schaffert, Kalz, 2009; Dabbagh, Kitsantas, 2012), asmeninius mokymosi tinklus (Couros, 2010), nurodo išskirtinę socialinių medijų svarbą. Tačiau toks socialinių medijų sureikšminimas siejamas su besimokančiųjų bendradarbiaujamosios sąveikos užtikrinimu. Šiame straipsnyje pristatomame tyrime siekiant visapusiškai įvertinti tinklalaidžių kaip socialinių medijų potencialą kuriant asmeninę mokymosi aplinką, asmeninį mokymosi tinklą, neapsiribota tik jų kaip socialinių medijų teikiamų bendradarbiavimo galimybių įvertinimu. Taikant integruoto informacinės elgsenos modelio tyrimo prieigą nustatant, kaip Lietuvos aukštųjų mokyklų studentai vertina tinklalaidžių neformaliojo savaiminio mokymosi potencialą: ar šios technologijos naudojamos asmeninei mokymosi aplinkai, asmeniniam mokymosi tinklui formuoti, buvo atliktas diskusijų grupių tyrimas. Tyrimo metu atlikta diskusijos dalyvių tinklalaidžių naudojimo analizė parodė, kad yra formuojama sąveika tarp pramogoms ir formaliajam bei neformaliajam mokymuisi naudojamo šių naujųjų medijų turinio. Tai reiškia, kad tyrimo dalyviai tinklalaides naudoja asmeninės mokymosi aplinkos kūrimui. Tačiau ši sąveika yra minimali, kuriama tik pačių besimokančiųjų, ji grindžiama mokymosi turinio tinklalaidžių saviieška. Diskusijos dalyvių patirčių analizė atskleidė, kad bendradarbiaujamoji sąveika tarp tyrime dalyvavusių besimokančiųjų ieškant, dalijantis, naudojant tinklalaides mokymuisi nėra intensyvi, jai būdingas fragmentiškumas. Tai leidžia pastebėti, kad neformaliojo mokymosi naudojant tinklalaides bendruomenės nesiformuoja. Tai rodo, kad tinklalaidžių potencialas neišnaudojamas dalyvaujamojo mokymosi tinklo kūrimui, tinklalaidės neinspiruoja dalyvaujamojo mokymosi

Asthma exacerbation and steroid burden in Australian primary care

Peer reviewedPostprin

Is Body Fat a Predictor of Race Time in Female Long-Distance Inline Skaters?

Purpose: The aim of this study was to evaluate predictor variables of race time in female ultra-endurance inliners in the longest inline race in Europe. Methods: We investigated the association between anthropometric and training characteristics and race time for 16 female ultraendurance inline skaters, at the longest inline marathon in Europe, the ‘Inline One-eleven’ over 111 km in Switzerland, using bi- and multivariate analysis. Results: The mean (SD) race time was 289.7 (54.6) min. The bivariate analysis showed that body height (r=0.61), length of leg (r=0.61), number of weekly inline skating training sessions (r=-0.51)and duration of each training unit (r=0.61) were significantly correlated with race time. Stepwise multiple regressions revealed that body height, duration of each training unit, and age were the best variables to predict race time. Conclusion: Race time in ultra-endurance inline races such as the ‘Inline One-eleven’ over 111 km might be predicted by the following equation (r2 = 0.65): Race time (min) = -691.62 + 521.71 (body height, m) + 0.58 (duration of each training unit, min) + 1.78 (age, yrs) for female ultra-endurance inline skaters

Military maladaptation : counterinsurgency and the politics of failure

Tactical learning is critical to battlefield success, especially in a counterinsurgency. This article tests the existing model of military adaption against a ‘most-likely’ case: the British Army’s counterinsurgency in the Southern Cameroons (1960–61). Despite meeting all preconditions thought to enable adaptation – decentralization, leadership turnover, supportive leadership, poor organizational memory, feedback loops, and a clear threat – the British still failed to adapt. Archival evidence suggests politicians subverted bottom-up adaptation, because winning came at too high a price in terms of Britain’s broader strategic imperatives. Our finding identifies an important gap in the extant adaptation literature: it ignores politics.PostprintPeer reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe