Child Exploitation and the FIFA World Cup: A review of risks and protective interventions

This review was commissioned by the Child Abuse Programme (CAP) of Oak Foundation, a large international philanthropic organisation. It forms part of CAP’s effort to win societal rejection of practices such as the sexual exploitation of children and adolescents around major sporting events (MSEs), and to embed prevention and protection from exploitation as a permanent concern for global sports-related bodies. This review is intended to inform action in countries that host MSEs and to provide some suggestions on how hosting countries can avoid past pitfalls and mistakes in relation to child exploitation, especially economic and sexual exploitation. Importantly, it also acts as a call to action by those responsible for commissioning and staging MSEs, such as FIFA and the IOC, to anticipate, prepare for and adopt risk mitigation strategies and interventions. Positive leadership from these culturally powerful bodies could prove decisive in shifting hearts, minds and actions in the direction of improved safety for children

Prospective validation study of transorbital Doppler ultrasound imaging for the detection of transient cerebral microemboli

Background: Transient cerebral microemboli are independent biomarkers of early risk of ischaemic stroke in acute carotid syndromes. Transcranial Doppler imaging (TCD) through the temporal bone is the standard method for detection of cerebral microemboli, but an acoustic temporal bone window for TCD is not available in around one in seven patients. Transorbital Doppler imaging (TOD) has been used when TCD is not possible. The aim of this study was to validate the use of TOD against TCD for detecting cerebral microemboli. Methods: The study included patients undergoing elective carotid endarterectomy; all had confirmed temporal and orbital acoustic windows. Subjects gave written informed consent to postoperative TCD and TOD monitoring, which was performed simultaneously for 30 min by two vascular scientists. Results: The study included 100 patients (mean(s.e.m.) age 72(1) years; 65 men). Microemboli were detected by one or both methods in 40·0 per cent of patients: by TOD and TCD in 24 patients, by TOD alone in ten and by TCD alone in six. For detecting microemboli, TOD had a sensitivity of 80·0 per cent, specificity of 86·1 per cent, positive predictive value of 71·6 per cent and negative predictive value of 91·2 per cent. Bland–Altman analysis revealed no significant bias (bias 0·11 (95 per cent c.i. −0·52 to 0·74) microemboli; P = 0·810) with upper and lower limits of agreement of +6 and −6 microemboli. Conclusion: TOD appears a valid alternative to TCD for detecting microembolic signals in patients with no suitable temporal acoustic window

Effects of breathing air containing 3% carbon dioxide, 35% oxygen or a mixture of 3% carbon dioxide/35% oxygen on cerebral and peripheral oxygenation at 150 m and 3459 m.

The effects of gas mixtures comprising supplementary 3% carbon dioxide, 35% oxygen or a combination of 3% CO(2) plus 35% O(2) in ambient air have been compared on arterial blood gases, peripheral and cerebral oxygenation and middle cerebral artery velocity (MCAV) at 150 m and on acute exposure to 3459 m in 12 healthy subjects. Breathing 3% CO(2) or 35% O(2) increased arterial blood oxygen at both altitudes, and the CO(2)/O(2) combination resulted in the most marked rise. MCAV increased on ascent to 3459 m, increasing further with 3% CO(2) and decreasing with 35% O(2) at both altitudes. The CO(2)/O(2) combination resulted in an increase in MCAV at 150 m, but not at 3549 m. Cerebral regional oxygenation fell on ascent to 3459 m. Breathing 3% CO(2) or 35% O(2) increased cerebral oxygenation at both altitudes, and the CO(2)/O(2) combination resulted in the greatest rise at both altitudes. The combination also resulted in significant rises in cutaneous and muscle oxygenation at 3459 m. The key role of carbon dioxide in oxygenation at altitude is confirmed, and the importance of this gas for tissue oxygenation is demonstrated