THE INFLUENCE OF CLASSROOM PHYSICAL ACTIVITY BREAKS AT DIFFERENT TIMES OF DAY ON ON-TASK BEHAVIOUR AND PHYSICAL ACTIVITY LEVELS IN PRIMARY SCHOOL CHILDREN

Classroom physical activity breaks (CAB) are beneficial for increasing children’s physical activity (PA) levels as well as the amount of time spent being on-task within the classroom. This study examined the effect of CAB at different times within the school day on on-task behaviour and PA levels in primary school (grade 1-3) children. Thirty-five children participated in CAB in four different conditions (within-subject): morning (AM), afternoon (PM), both the morning and afternoon (BOTH), and no CAB (CTRL). PA levels were monitored via activPAL accelerometers for 24 h starting at the beginning of the school day. On-task behaviour was observed for 45-140 min following each CAB, with the amount of time students spent being on-task as well as 3 types of off-task (motor, verbal, and passive) being recorded. When compared to control, the AM condition and PM condition increased on-task behaviour (AM: Δ10.4%, p\u3c0.001, PM: Δ10.5%, p\u3c0.001), while performing BOTH CAB increased on-task behaviour even further (Δ14%, p\u3c0.001). The AM condition was most beneficial for reducing off-task motor (Δ-6.5%) and off-task verbal (Δ-3%) behaviour, while the PM condition was most beneficial for reducing off-task passive (Δ-9%) behaviour. These effects were greatest in those students demonstrating higher amounts off-task behaviour during CTRL (r\u3e0.67, p\u3c0.001). Students participated in an additional 8.4 min (p=0.07), 12.2 min (p\u3c0.001), and 6.3 min (p=0.09) of 24 h moderate-vigorous physical activity (MVPA) following a CAB vs CTRL in the AM, PM, and BOTH conditions, respectively. Additionally, performing any of the CAB conditions increased the number of steps taken during the school day, by an average of 2007 steps (p\u3c0.009). Overall, these results demonstrate that CAB improve both on-task behaviour and PA levels, regardless of time of day. However, performing two CAB (BOTH) is recommended to derive the greatest improvements in on-task behaviour and all types of off-task behaviour across the school day

A horizon scan of global conservation issues for 2014

This paper presents the output of our fifth annual horizon-scanning exercise, which aims to identify topics that increasingly may affect conservation of biological diversity, but have yet to be widely considered. A team of professional horizon scanners, researchers, practitioners, and a journalist identified 15 topics which were identified via an iterative, Delphi-like process. The 15 topics include a carbon market induced financial crash, rapid geographic expansion of macroalgal cultivation, genetic control of invasive species, probiotic therapy for amphibians, and an emerging snake fungal disease. © 2013 Elsevier Ltd

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p&lt;0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p&lt;0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p&lt;0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP &gt;5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Effects of an acute session of high- vs low-load resistance training exercise on energy balance

This study examined the effect of an acute session of low-load high-volume resistance training versus a more traditional high-load low-volume session on energy balance (EB). Five recreationally active males (age: 24±3 y; BMI: 25.8±1.5 kgm-2) completed three different sessions: 1) high-load (90% 1RM); 2) low-load (30% 1RM); and 3) CTRL (no exercise). Gas exchange (V̇O2), blood lactate, and subjective appetite perceptions were measured before each session, as well as at 0, 1, and 2 h post-exercise. Delayed onset muscle soreness (DOMS) in the quadriceps, pectorals, hamstrings, deltoids, and latissimus dorsi was measured at 24 and 48 h post-exercise. V̇O2 was increased following the 30% 1RM (D0.110 L×min-1, p\u3c0.001, d = 1.41) and 90% 1RM (D0.08 L×min-1, p=0.002, d = 1.22) sessions compared to CTRL at 0 h post-exercise. Post-exercise energy expenditure (EE) was trending (p=0.088, ) to be greater following the 30% 1 RM session compared to CTRL (∆41 kcal, p=0.091, d = 1.30). The 30% 1RM session accumulated more plasma lactate at 0 and 1 h post-exercise than both 90% 1RM (D5.7 mmol×L-1, p\u3c0.001, d = 2.65; D1.1 mmol×L-1, p=0.010, d = 2.10) and CTRL (∆13.0 mmol×L-1, p\u3c0.001, d = 7.38; ∆1.8 mmol×L-1, p=0.001, d = 2.44) sessions. The 30% 1RM session subsequently resulted in lower appetite at both 0 (∆26 mm, p=0.003, d = -0.62) and 1 h (∆24 mm, p=0.005, d = -0.60) post-exercise compared to the 90% 1RM session, and was lower than CTRL at 0 (∆42 mm, p\u3c0.001, d = -1.29), 1 (∆35 mm, p=0.001, d = -0.93), and 2 h (∆21 mm, p=0.017, d = -1.13) post-exercise. These results demonstrate a low-load high-volume resistance training session elevates post-exercise V̇O2/EE, blood lactate, and decreases subjective appetite compared to high-load low-volume suggesting more positive benefits to energy balance. However, due to the COVID-19 pandemic all results remain preliminary

The effects of a pre-exercise meal on postexercise metabolism following a session of sprint interval training

Sprint interval training (SIT) has demonstrated reductions in fat mass through potential alterations in post-exercise metabolism. This study examined whether exercising in the fasted or fed state affects post-exercise metabolism following acute SIT. Ten active males performed a bout of modified SIT (8 x 15 s sprints; 120 s recovery) in both a fasted (FAST) and fed (FED) state. Gas exchange was collected through 3 h post-exercise, appetite perceptions were measured using a visual analog scale, and energy intake was recorded using dietary food logs. There was no difference in energy expenditure between conditions at any time point (p>0.329) or in total session energy expenditure (FED: 514.854.9 kcal, FAST: 504.074.3 kcal; p=0.982). Fat oxidation 3 h post-exercise was higher in FED (0.1100.04 gmin-1) versus FAST (0.0690.02 gmin-1; p=0.013) though not different between conditions across time (p>0.340), or in total post-exercise fat oxidation (FED: 0.1250.04 gmin-1>, FAST: 0.1050.02 gmin-1; p=0.154). Appetite perceptions were lower in FED (-4815.04098.7 mm) versus FAST (-707.52010.4 mm, p=0.022), however energy intake did not differ between conditions (p=0.429). These results demonstrate the fasted or fed state does not augment post-exercise metabolism following acute SIT in a way that would favour fat loss following training. • Energy expenditure was similar between conditions, while fat oxidation was significantly greater in FED at 3 h post-exercise • Appetite perceptions were significantly lower in FED, however energy intake was not different between conditions • Current findings suggest that performing SIT in the fed or fasted state would not affect fat loss following trainingThe accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Identification and analysis of functional elements in 1% of the human genome by the ENCODE pilot project.

We report the generation and analysis of functional data from multiple, diverse experiments performed on a targeted 1% of the human genome as part of the pilot phase of the ENCODE Project. These data have been further integrated and augmented by a number of evolutionary and computational analyses. Together, our results advance the collective knowledge about human genome function in several major areas. First, our studies provide convincing evidence that the genome is pervasively transcribed, such that the majority of its bases can be found in primary transcripts, including non-protein-coding transcripts, and those that extensively overlap one another. Second, systematic examination of transcriptional regulation has yielded new understanding about transcription start sites, including their relationship to specific regulatory sequences and features of chromatin accessibility and histone modification. Third, a more sophisticated view of chromatin structure has emerged, including its inter-relationship with DNA replication and transcriptional regulation. Finally, integration of these new sources of information, in particular with respect to mammalian evolution based on inter- and intra-species sequence comparisons, has yielded new mechanistic and evolutionary insights concerning the functional landscape of the human genome. Together, these studies are defining a path for pursuit of a more comprehensive characterization of human genome function