Using Wireless Pedometers to Measure Children’s Physical Activity: How Reliable is the Fitbit Zip?

The purpose of this study is to examine the reliability of wireless pedometers in measuring elementary school children’s physical activity. Activity measurement using a wireless pedometer Fitbit ZipTM was compared to activity measurement using Yamax Digi-WalkerTM SW701 for a group of randomly selected 25 children in Grades 3, 4, and 5. Fitbit ZipTM wireless pedometers were found to have an appropriate degree (Nunnally & Bernstein, 1994) of accuracy and reliability compared to the Yamax Digi-WalkerTM SW701 pedometer. The Fitbit ZipTM wireless pedometer collected more step counts than the Yamax Digi-WalkerTM SW701 pedometer; however, the difference was not statistically significant. Participants reported that they preferred wearing the Fitbit ZipTM to the Yamax Digi-WalkerTM SW701 because the Fitbit ZipTM was more comfortable to wear and less likely to fall off. Participants also reported being more motivated to move while wearing the Fitbit ZipTM

READY TO LEARN: THE IMPACT OF THE MORNING BLAST PHYSICAL ACTIVITY INTERVENTION ON ELEMENTARY SCHOOL STUDENTS

Objective: The purpose of this study was to investigate the effects of a physical activity intervention programme, named “Morning Blast”, on elementary school students’ math learning and daily physical activity. The Morning Blast intervention programme was a 16-week cardiovascular endurance emphasized physical activity program that students voluntarily participated in before the school day. Participants that volunteered, did so for the duration of the program. Methods: This mixed-methods study included seven educators and 83 students (n=90). The students were all children who were enrolled in Grades 3, 4, and 5 in a semi-rural elementary school in the United States. Data were collected through focus-group interviews, surveys, quantitative analysis of step counts, and from quasi-experimental research design. Results: Students in the experimental group were found to have: (1) increased scores on math standard score, (2) greater confidence in their academic ability, and (3) had more accumulated steps compared to students in the control group. Students in the experimental group also reported that they were more “ready to learn” after completing the physical activity intervention. This finding was also confirmed by their teachers. Conclusion: This study demonstrates how an increase in physical activity during the morning time has positive benefits for students throughout the school day

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The purpose of this study is to examine the reliability of wireless pedometers in measuring elementary school children’s physical activity. Activity measurement using a wireless pedometer Fitbit ZipTM was compared to activity measurement using Yamax Digi-WalkerTM SW701 for a group of randomly selected 25 children in Grades 3, 4, and 5. Fitbit ZipTM wireless pedometers were found to have an appropriate degree (Nunnally & Bernstein, 1994) of accuracy and reliability compared to the Yamax Digi-WalkerTM SW701 pedometer. The Fitbit ZipTM wireless pedometer collected more step counts than the Yamax Digi-WalkerTM SW701 pedometer; however, the difference was not statistically significant. Participants reported that they preferred wearing the Fitbit ZipTM to the Yamax Digi-WalkerTM SW701 because the Fitbit ZipTM was more comfortable to wear and less likely to fall off. Participants also reported being more motivated to move while wearing the Fitbit ZipTM

Endoplasmic reticulum stress increases glucose production in vivo via effects on liver glycogenolysis and glucose-6-phosphatase activity

Recent evidence suggests that endoplasmic reticulum (ER) stress can induce impairments in both insulin secretion and insulin action. The aim of the present study was to examine the effects of ER stress on glucose production in vivo. Fasted rats were anesthetized and catheters were placed in the carotid artery, jugular vein, and jejunal vein. A pancreatic clamp was performed in which somatostatin was infused to inhibit pancreatic insulin and glucagon secretion. These hormones were then replaced at basal levels. To examine the effects of ER stress on glucose production, 6,6-2H2 Glucose was infused in the absence (CON, n =4) or presence of jejunal vein tunicamycin delivery (TUN, n =6). TUN induces ER stress through inhibition of protein glycosylation. Arterial insulin, glucagon, corticosterone, and free fatty acid concentrations were constant throughout experiments and were not different between groups. Glucose concentration and production increased by 76.2+-24.2 mg/dl and 2.6+-1.2 mg/kg/min (mean+-SDEV), respectively, in TUN, but did not change in CON. Liver glucose-6-phosphatase (G6Pase) and phosphoenopyruvate carboxykinase mRNA were not different between groups. Liver, but not kidney, G6Pase activity (nmoles/mg protein/30min) was increased in TUN (7.2+-2.1) vs. CON (0.2+-0.3). Liver glycogen concentration was reduced by 62% in TUN vs. CON. These data suggest that experimental induction of ER stress can increase the production of glucose in vivo, in part, via activation of hepatic glycogenolysis and G6Pase.College Honors

Deletion of the Basement Membrane Heparan Sulfate Proteoglycan Type XVIII Collagen Causes Hypertriglyceridemia in Mice and Humans

Background: Lipoprotein lipase (Lpl) acts on triglyceride-rich lipoproteins in the peripheral circulation, liberating free fatty acids for energy metabolism or storage. This essential enzyme is synthesized in parenchymal cells of adipose tissue, heart, and skeletal muscle and migrates to the luminal side of the vascular endothelium where it acts upon circulating lipoproteins. Prior studies suggested that Lpl is immobilized by way of heparan sulfate proteoglycans on the endothelium, but genetically altering endothelial cell heparan sulfate had no effect on Lpl localization or lipolysis. The objective of this study was to determine if extracellular matrix proteoglycans affect Lpl distribution and triglyceride metabolism. Methods and Findings: We examined mutant mice defective in collagen XVIII (Col18), a heparan sulfate proteoglycan present in vascular basement membranes. Loss of Col18 reduces plasma levels of Lpl enzyme and activity, which results in mild fasting hypertriglyceridemia and diet-induced hyperchylomicronemia. Humans with Knobloch Syndrome caused by a null mutation in the vascular form of Col18 also present lower than normal plasma Lpl mass and activity and exhibit fasting hypertriglyceridemia. Conclusions: This is the first report demonstrating that Lpl presentation on the lumenal side of the endothelium depends on a basement membrane proteoglycan and demonstrates a previously unrecognized phenotype in patients lacking Col18.National Institute of Health (NIH)[HL087228]National Institute of Health (NIH)[GM33063]National Institute of Health (NIH)[HL67255]CEPID/FAPESPCNPqUniversity of Colorado Denver Department of MedicineLeducq FoundationAmerican Heart Association[0735038N

Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times: a Cluster Randomized Clinical Trial

IMPORTANCE: The benefit of endovascular stroke therapy (EVT) in large vessel occlusion (LVO) ischemic stroke is highly time dependent. Process improvements to accelerate in-hospital workflows are critical. OBJECTIVE: to determine whether automated computed tomography (CT) angiogram interpretation coupled with secure group messaging can improve in-hospital EVT workflows. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized stepped-wedge clinical trial took place from January 1, 2021, through February 27, 2022, at 4 comprehensive stroke centers (CSCs) in the greater Houston, Texas, area. All 443 participants with LVO stroke who presented through the emergency department were treated with EVT at the 4 CSCs. Exclusion criteria included patients presenting as transfers from an outside hospital (n = 158), in-hospital stroke (n = 39), and patients treated with EVT through randomization in a large core clinical trial (n = 3). INTERVENTION: Artificial intelligence (AI)-enabled automated LVO detection from CT angiogram coupled with secure messaging was activated at the 4 CSCs in a random-stepped fashion. Once activated, clinicians and radiologists received real-time alerts to their mobile phones notifying them of possible LVO within minutes of CT imaging completion. MAIN OUTCOMES AND MEASURES: Primary outcome was the effect of AI-enabled LVO detection on door-to-groin (DTG) time and was measured using a mixed-effects linear regression model, which included a random effect for cluster (CSC) and a fixed effect for exposure status (pre-AI vs post-AI). Secondary outcomes included time from hospital arrival to intravenous tissue plasminogen activator (IV tPA) bolus in eligible patients, time from initiation of CT scan to start of EVT, and hospital length of stay. In exploratory analysis, the study team evaluated the impact of AI implementation on 90-day modified Rankin Scale disability outcomes. RESULTS: Among 243 patients who met inclusion criteria, 140 were treated during the unexposed period and 103 during the exposed period. Median age for the complete cohort was 70 (IQR, 58-79) years and 122 were female (50%). Median National Institutes of Health Stroke Scale score at presentation was 17 (IQR, 11-22) and the median DTG preexposure was 100 (IQR, 81-116) minutes. In mixed-effects linear regression, implementation of the AI algorithm was associated with a reduction in DTG time by 11.2 minutes (95% CI, -18.22 to -4.2). Time from CT scan initiation to EVT start fell by 9.8 minutes (95% CI, -16.9 to -2.6). There were no differences in IV tPA treatment times nor hospital length of stay. In multivariable logistic regression adjusted for age, National Institutes of Health Stroke scale score, and the Alberta Stroke Program Early CT Score, there was no difference in likelihood of functional independence (modified Rankin Scale score, 0-2; odds ratio, 1.3; 95% CI, 0.42-4.0). CONCLUSIONS AND RELEVANCE: Automated LVO detection coupled with secure mobile phone application-based communication improved in-hospital acute ischemic stroke workflows. Software implementation was associated with clinically meaningful reductions in EVT treatment times. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05838456

Evaluation of a student-run smoking cessation clinic for a medically underserved population

<p>Abstract</p> <p>Background</p> <p>Smoking is common among medically underserved populations. Accessible resources to encourage and support smoking cessation among these patients are limited. Volunteer medical student-run free smoking cessation clinics may provide an effective option to help these individuals achieve smoking abstinence. In order to demonstrate the feasibility and cost-effectiveness of a student-run clinic, we analyzed a case series of patients receiving care in a medical student-run Smoking Cessation Clinic (SCC) at the Rochester, Minnesota Salvation Army Good Samaritan Health Clinic (GSHC).</p> <p>Findings</p> <p>Between January 2005 and March 2009, 282 cigarette smokers seeking care at the SCC were analyzed. Student providers at the SCC conducted 1652 weekly individual counseling sessions averaging 18 minutes per encounter. Patients were offered a choice of pharmacotherapies including nicotine replacement therapy (NRT), bupropion, and varenicline for up to 12 weeks. Smoking abstinence was confirmed with exhaled carbon monoxide (CO). Thirty-two patients completed the entire 12-week program (11.3%). At last contact, 94 patients (33.3%) abstained from smoking for ≥ 7 days and 39 patients (13.8%) were continuously abstinent for ≥ 4 weeks. The 7-day point prevalence abstinence rates at last contact were 58.6% for varenicline, 41.2% for bupropion, 33.9% for NRT, and 23.5% for bupropion and NRT. Analyzing missing patients as smoking, the 7-day point prevalence abstinence rates were 7.1%, 8.9%, and 8.2%, at 1 month, 2 months, and 3 months after program enrollment, respectively. No serious adverse drug reactions were recorded.</p> <p>Conclusions</p> <p>Our medical student-run smoking cessation clinic provided an effective and safe experience for medically underserved patients who might not otherwise have access to conventional smoking cessation programs because of high cost, lack of insurance, or other disparities. Similar medical student initiatives focusing on healthy lifestyles may be feasible and beneficial for individuals with limited access to healthcare resources.</p

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