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This is an overview of the results from 14 countries or jurisdictions in a Global Matrix of Para Report Cards on physical activity (PA) of children and adolescents with disabilities. The methodology was based on the Active Healthy Kids Global Alliance's Global Matrix 4.0. Data were aligned with 10 indicators (Overall PA, Organized Sport, Active Play, Active Transport, Physical Fitness, Sedentary Behavior, Family & Peers, Schools, Community & Environment, and Government) to produce Para Report Cards. Subsequently, there were 139 grades; 45% were incomplete, particularly for Active Play, Physical Fitness, and Family & Peers. Collectively, Overall PA was graded the lowest (F), with Schools and Government the highest (C). Disability-specific surveillance and research gaps in PA were apparent in 14 countries or jurisdictions around the world. More coverage of PA data in Para Report Cards is needed to serve as an advocacy tool to promote PA among children and adolescents with disabilities.

The purpose was to synthesize information gathered from the interpretation and conclusion sections of the Global Matrix of Para Report Cards on the physical activity of children and adolescents with disabilities. The synthesis was based on the strengths, weaknesses, opportunities, and threats framework. The procedure consisted of three stages: (a) the application of the International Classification of Functioning, Disability and Health as the theoretical framework; (b) identifying and aligning Global Matrix indicators and benchmarks with the International Classification of Functioning, Disability and Health components through a Delphi approach; and (c) using content analysis to identify themes from specific report cards. Outcomes reveal that further attention toward including children and adolescents with disabilities in fitness assessments is needed as well as adapted assessment methods. Program availability, equipment and facilities, and professional training emerged as strengths but need further development to overcome weaknesses. Paralympic inspiration was an opportunity, whereas extreme weather conditions presented potential threats to physical activity participation among children and adolescents with disabilities.

Background: Physical inactivity among children and adolescents with disabilities (CAWD) is a global public health issue. Policy efforts to promote physical activity (PA) among CAWD have increased. This study summarizes the international policy trend for promoting PA among CAWD, with behavioral and policy insights specific to CAWD from country/regional indicators from the Active Healthy Kids Global Alliance Matrix on Physical Activity for Children and Adolescents to determine policy translation into practice., Methods: International and national PA policy documents on CAWD were assessed. Data from the Global Matrix Para Report Cards on the behavioral and government indicators from 14 countries or regions (grouped by human development index) were reviewed and compared., Results: Policy instruments began promoting PA for CAWD in 1989 via the Convention on the Rights of the Child. International policy has been advocating PA specifically for CAWD recently. In 2020, the World Health Organization published specific PA guidelines for CAWD. Data from the 14 Para Report Car found 14 grades on the average behavioral indicator and 12 on the government indicator. A gap between the average behavioral indicator (D-) and the government indicator (C+) was found in the Para Report Card data., Conclusions: Although international policies are consistent in their attention to the needs of CAWD, national/regional policies vary. Coverage ranges from nonexistent to embedded in broader inclusion concepts. A gap in policies to promote PA of CAWD is prevalent and is more prominent in countries or regions with a lower human development index ranking.

Background: This study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex., Methods: Cross-sectional data from the IPEN Adolescent study, an observational multi-country study, were used. Participants wore an accelerometer for seven days, reported height and weight, and completed a socio-demographic survey. In total, 4852 adolescents (46.6% boys), aged 11-19 years (mean age = 14.6, SD = 1.7 years) were included in the analyses, using generalized additive mixed models., Results: Adolescents accumulated on average 41.3 (SD = 22.6) min/day of MVPA and 531.8 (SD = 81.1) min/day of ST, and the prevalence of overweight and obesity was 17.2% (IOTF), but these mean values differed by country. Linear negative associations of accelerometer-based MVPA and ST with standardized BMI scores and the likelihood of being overweight/obese were found. School-based ST and non-school-based MVPA were more strongly negatively associated to the outcomes than non-school based ST and school-based MVPA. Study site moderated the associations; adolescent sex did not. No curvilinear associations were found., Conclusions: This multi-country study confirmed the importance of MVPA as a potential protective factor against overweight/obesity in adolescents. Non-school-based MVPA seemed to be the main driver of these associations. Unexpected results were found for ST, calling for further examination in methodologically sound international studies but using inclinometers or pressure sensors to provide more precise ST measures., (© 2022. The Author(s).)

Bladder paragangliomas (bPGL) are rare neuroendocrine tumors arising from the sympathetic paraganglia present in the bladder wall. Bladder PGLs are typically submucosal or intramural but when subserosal may not be readily visible at cystoscopy. The average size at presentation is 3.9 cm (range 1.0-9.1 cm). When small, bPGL are usually spherical, well-marginated and homogeneous. Larger bPGL are typically more complex with peri- and intra-tumoral neovascularity and central necrosis. On ultrasound, increased color Doppler signal is typical. The increased soft tissue resolution of MRI enables localization of bPGL within the bladder wall more accurately than CT. Restricted diffusion and avid contrast enhancement help differentiate small bPGLs from leiomyomas, which have similar appearances on ultrasound and CT. Nuclear medicine techniques identify bPGLs and their metastases with high specificity, 68 Ga-DOTATATE PET/CT having largely replaced 123 I-mIBG SPECT/CT as the first line functional investigation. Imaging is essential to aid surgical planning, as endoscopic resection is often not possible or incomplete due to tumor location. For patients with advanced disease, 68 Ga-DOTATATE PET/CT and 123 I-mIBG SPECT/CT assess suitability for peptide receptor radionuclide therapy. Up to 63% of bPGL patients have a germline mutation, most commonly in the SDHB subunit gene, increasing their risk of developing pheochromocytomas and further paragangliomas; lifelong annual biochemical and periodic imaging screening from skull base to pelvis is therefore recommended., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Public reimbursement systems face the challenge of balancing provision of needed treatments and the reality of limited resources. Canada has a complex system for drug approval and public reimbursement, with jurisdiction divided between the federal government and the provinces/territories. A pivotal role is that of health technology assessment (HTA), which relies primarily on health economic principles to analyze the value of drugs on a population health basis and make recommendations about public reimbursement. The Canadian Agency for Drugs and Technologies in Health (CADTH) provides recommendations to all provinces but Quebec. This article provides an overview of Canada's approval and public reimbursement pathway, including the role of HTA and the economic principles on which it relies. Starting in late 2020, CADTH reduced the cost per quality-adjusted life year (QALY) threshold, the metric relied upon in making recommendations to public payers. An analysis of all 56 oncology drug final recommendations issued from January 2020 to January 2022 was conducted and confirms this reduction in the cost per QALY threshold. As a result of this threshold reduction, recommendations to the provinces include, in a number of cases, substantially greater price reductions. The potential implications for successful price negotiation with the pan-Canadian Pharmaceutical Alliance (pCPA), the public negotiating body for the provinces, are discussed.

The prognosis for extensive-stage small cell lung cancer (ES-SCLC) is poor. Real-world evidence can highlight the unmet clinical need within this population. We conducted a population-based cohort study of ES-SCLC patients diagnosed in a large Canadian province (2010-2018) using electronic medical records and administrative claims data. In all, 1941 ES-SCLC patients were included, of which 476 (25%) were recurrent cases. Median age at diagnosis was 70 years (range: 39-94) and 50.2% were men. Of the 1941 ES-SCLC patients, 29.5% received chemotherapy and radiotherapy, 17.0% chemotherapy alone, 8.7% radiotherapy alone, and 44.8% received best supportive care. Chemotherapy was initiated by 46.5%, 8.5%, and 1.4% of first-, second-, and third-line patients, with lower uptake for recurrent cases. Median survival from first-, second-, and third-line chemotherapy was 7.82 months (95% CI: 7.50-8.22), 5.72 months (95% CI: 4.90-6.87), and 3.83 months (95% CI: 2.99-4.60). Among patients who received first-line therapy, the 2-year and 5-year survival was 7.3% (95% CI: 5.7-9.2) and 2.9% (95% CI: 1.8-4.5). In conclusion, initiation of first-line treatment in ES-SCLC was low with significant attrition in subsequent lines. These results underscore the need for effective front-line treatments and highlight the potential for novel therapies to improve patient outcomes.

Objectives: To evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADC mean ) and 18 F-FDG PET maximum standardized uptake value (SUV max ) to predict disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC), and to determine whether this ability is influenced by human papillomavirus oropharyngeal cancer (HPV-OPC) status., Methods: This prospective cohort observational study included 65 participants (53 male, mean ± SD age 59.9 ± 7.9 years, 46 HPV-OPC) with stage III or IV HNSCC. Primary tumour and nodal ADC mean  (pre-treatment, 6- and 12-weeks post-CRT) and SUV max  (12-weeks post-CRT) were measured. Variables were compared with 2-year DFS (independent t-test/Mann-Whitney test) and overall DFS (Cox regression), before and after accounting for HPV-OPC status. Variables were also compared between HPV-OPC and other HNSCC subgroups after stratifying for DFS., Results: Absolute post-CRT ADC mean  values predicted 2-year DFS and overall DFS for all participants (p = 0.03/0.03, 6-week node; p = 0.02/0.03 12-week primary tumour) but not in the HPV-OPC subgroup. In participants with DFS, percentage interval changes in primary tumour ADC mean  at 6- and 12-weeks were higher in HPV-OPC than other HNSCC (p = 0.01, 6 weeks; p = 0.005, 12 weeks). The 12-week post-CRT SUV max  did not predict DFS., Conclusion: Absolute post-CRT ADC mean  values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADC mean  were significantly higher in HPV-OPC than in other HNSCC. Knowledge of HPV-OPC status is crucial to the clinical utilisation of post-CRT DWI-MRI for the prediction of outcomes.

Background: Posttreatment diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxygluocose ( 18 F-FDG) positron emission tomography (PET) with computed tomography (PET/CT) have potential prognostic value following chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Correlations between these PET/CT (standardized uptake value or SUV) and DW-MRI (apparent diffusion coefficient or ADC) parameters have only been previously explored in the pretreatment setting., Aim: To evaluate stage III and IV HNSCC at 12-weeks post-CRT for the correlation between SUV max and ADC values and their interval changes from pretreatment imaging., Methods: Fifty-six patients (45 male, 11 female, mean age 59.9 + - 7.38) with stage 3 and 4 HNSCC patients underwent 12-week posttreatment DW-MRI and 18 F-FDG PET/CT studies in this prospective study. There were 41/56 patients in the cohort with human papilloma virus-related oropharyngeal cancer (HPV OPC). DW-MRI (ADC max and ADC min) and 18 F-FDG PET/CT (SUV max and SUV max ratio to liver) parameters were measured at the site of primary tumors (n = 48) and the largest lymph nodes (n = 52). Kendall's tau evaluated the correlation between DW-MRI and 18 F-FDG PET/CT parameters. Mann-Whitney test compared the post-CRT PET/CT and DW-MRI parameters between those participants with and without 2-year disease-free survival (DFS)., Results: There was no correlation between DW-MRI and 18 F-FDG PET/CT parameters on 12-week posttreatment imaging (P = .455-.794; tau = -0.075-0.25) or their interval changes from pretreatment to 12-week posttreatment imaging (P = .1-.946; tau = -0.194-0.044). The primary tumor ADC mean (P = .03) and the interval change in nodal ADC min (P = .05) predicted 2-year DFS but none of the 18 F-FDG PET/CT parameters were associated with 2-year DFS., Conclusions: There is no correlation between the quantitative DWI-MRI and 18 F-FDG PET/CT parameters derived from 12-week post-CRT studies. These parameters may be independent biomarkers however in this HPV OPC dominant cohort, only selected ADC parameters demonstrated prognostic significance. Study was prospectively registered at http://www.controlled-trials.com/ISRCTN58327080., (© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.)

By adopting Sport Education into the university context, this study examined how lesson content and teacher interaction contribute to university students' physical activity levels during physical education lessons. Following a continuing professional development workshop, a 10-week Sport Education season was designed collaboratively and implemented at a university, taking into account the university's facilities. This study used the momentary time sampling tool, System for Observing Fitness Instruction Time, in which eight teachers and 202 students (72% male) were videotaped in 156 lessons. The data on physical activity levels, lesson content, and teacher behavior were collected and analyzed. The student-participants engaged in an average of 38.77 (±18.78) moderate-to-vigorous physical activity (MVPA) minutes which did not meet the recommendation of 50% lesson time. Findings of hierarchical linear regression indicated that knowledge (β = 0.29) and general content (β = 0.29) contributed to the sitting physical activity while skill practices (β = 0.25) and gameplay (β = 0.38) predicted the MVPA. Practical implications of utilizing the features of Sport Education in boosting the intensity of activities are discussed, especially team affiliation, formal competition, and record keeping. Further investigations are proposed on the interaction of gameplay content and teacher behavior with larger sample size., (© Journal of Sports Science and Medicine.)

Background: Globally, the rising cost of anticancer therapy has motivated efforts to quantify the overall value of new cancer treatments. Multicriteria decision analysis offers a novel approach to incorporate multiple criteria and perspectives into value assessment., Methods: The authors recruited a diverse, multistakeholder group who identified and weighted key criteria to establish the drug assessment framework (DAF). Construct validity assessed the degree to which DAF scores were associated with past pan-Canadian Oncology Drug Review (pCODR) funding recommendations and European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS; version 1.1) scores., Results: The final DAF included 10 criteria: overall survival, progression-free survival, response rate, quality of life, toxicity, unmet need, equity, feasibility, disease severity, and caregiver well-being. The first 5 clinical benefit criteria represent approximately 64% of the total weight. DAF scores ranged from 0 to 300, reflecting both the expected impact of the drug and the quality of supporting evidence. When the DAF was applied to the last 60 drugs (with reviewers blinded) reviewed by pCODR (2015-2018), those drugs with positive pCODR funding recommendations were found to have higher DAF scores compared with drugs not recommended (103 vs 63; Student t test P = .0007). DAF clinical benefit criteria mildly correlated with ESMO-MCBS scores (correlation coefficient, 0.33; 95% CI, 0.009-0.59). Sensitivity analyses that varied the criteria scores did not change the results., Conclusions: Using a structured and explicit approach, a criterion-based valuation framework was designed to provide a transparent and consistent method with which to value and prioritize cancer drugs to facilitate the delivery of affordable cancer care., (© 2019 American Cancer Society.)

Objectives: To explore the attitudes of United Kingdom (UK) medical students regarding artificial intelligence (AI), their understanding, and career intention towards radiology. We also examine the state of education relating to AI amongst this cohort., Methods: UK medical students were invited to complete an anonymous electronic survey consisting of Likert and dichotomous questions., Results: Four hundred eighty-four responses were received from 19 UK medical schools. Eighty-eight percent of students believed that AI will play an important role in healthcare, and 49% reported they were less likely to consider a career in radiology due to AI. Eighty-nine percent of students believed that teaching in AI would be beneficial for their careers, and 78% agreed that students should receive training in AI as part of their medical degree. Only 45 students received any teaching on AI; none of the students received such teaching as part of their compulsory curriculum. Statistically, students that did receive teaching in AI were more likely to consider radiology (p = 0.01) and rated more positively to the questions relating to the perceived competence in the post-graduation use of AI (p = 0.01-0.04); despite this, a large proportion of students in the taught group reported a lack of confidence and understanding required for the critical use of healthcare AI tools., Conclusions: UK medical students understand the importance of AI and are keen to engage. Medical school training on AI should be expanded and improved. Realistic use cases and limitations of AI must be presented to students so they will not feel discouraged from pursuing radiology.

Cultural differences in aggression are still poorly understood. The purpose of this article is to assess whether a tool for measuring aggression has the same meaning across cultures. Analyzing samples from Spain ( n  = 262), the United States ( n  = 344), and Hong Kong ( n  = 645), we used confirmatory factor analysis to investigate measurement invariance of the refined version of the Aggression Questionnaire (Bryant & Smith, 2001 ). The measurement of aggression was more equivalent between the Chinese and Spanish versions than between these two and the U.S. version. Aggression does not show invariance at the cultural level. Cultural variables such as affective autonomy or individualism could influence the meaning of aggression. Aggressive behavior models can be improved by incorporating cultural variables.

Evidence suggests that adolescent males take part in more moderate-to-vigorous physical activity (MVPA) than females, and that adolescents with disabilities participate in even less. Public health data are typically based on the international physical activity (PA) recommendations of at least 60 minutes of MVPA daily. However, it appears that data are lost because a person who reports MVPA 0-6 days a week is grouped together and is considered as 'inactive'. Therefore, the purposes of this study were to report differences among adolescents with and without disabilities who were 'active' and 'inactive' and to explore differences by sex. A complete enumeration study (2017 School Health Promotion Survey; n = 128,803) of Finnish adolescents aged between 14-19 years old was conducted. The single item self-report MVPA was used with items from the Washington Group on Disability Statistics. Data were grouped into physiological and cognitive disabilities and were split into active and inactive adolescents based on the PA recommendations; subsequently, binary logistic regression analyses were performed. Data from the inactive participants were analyzed with multivariate analysis of covariance and effect sizes were reported. Approximately 10% of males and 17% of females reported disabilities. There were fewer adolescents with disabilities who took part in daily PA (OR = 0.90, CI = 0.85-0.94), especially among those with cognitive disabilities (OR = 0.86, CI = 0.82-0.91). There were more active male than female adolescents (OR = 1.48, CI = 1.43-1.52). Of the inactive adolescents, females reported similar MVPA to males, with and without disabilities after controlling for age, school type, and family financial situation. Inactive adolescents with walking difficulties reported the least amount of MVPA (males; mean = 2.24, CI = 2.03-2.44, females; mean = 2.18, CI = 1.99-2.37). The difference in means with adolescents without disabilities according to Cohen's d effect size was medium for males (0.56) and females (0.58). The effect sizes from all other groups of disabilities were small. The difference in PA between males and females has diminished among the inactive groups, yet there is still a need to improve the gap between males and females, especially for those who meet the PA recommendations. More strategies are needed to improve MVPA among adolescents with disabilities, especially those with cognitive disabilities.

The purpose of this study was to examine the physical activity (PA) of children with physical disabilities (PD) and its associated environmental and behavioral factors at home and at school. One hundred and forty-seven Hong Kong children (mean age = 13.5 ± 2.5 years) with PD from three special schools participated. We used BEACHES (Behaviors of Eating and Activity for Children's Health: Evaluation System) to assess their PA and associated variables at home (before dinner) and during four school settings (before classes, recess, lunch breaks, after classes) on four school days. Overall, the children were typically inactive and spent little time in moderate-to-vigorous physical activity (MVPA), range = 6.3% to 17.0% across settings. At home, children were more active when fathers were present ( p < 0.001). At school, prompts to be active contributed to their MVPA% before classes ( p < 0.01) and during recess and lunch breaks (both p < 0.001). The presence of a child's mother was positively associated with MVPA% before classes ( p < 0.001) and the presence of other children was associated with MVPA% during recess and lunch breaks (both p < 0.05). With children with PD accruing small amounts of MVPA in both home and school settings, multifaceted interventions reflecting both contextual and personal factors should be considered in order to increase the health-enhancing PA of this population.

Background: Molecular testing in advanced lung cancer is standard in guiding treatment selection. However, population-wide implementation of testing remains a challenge. We developed a knowledge translation intervention to improve understanding among diagnostic specialists about molecular testing and appropriate diagnostic sampling in lung cancer., Methods: Specialty-specific education programs were developed from existing literature and input from Canadian leaders in lung pathology, respirology, interventional radiology, thoracic surgery, radiation oncology, and medical oncology. The programs, including key messages, review of current data, existing guidelines, group discussion, and participant feedback, were administered at provincial and national specialty meetings. Participant knowledge was assessed before and after the intervention by using anonymous questionnaires. Molecular (EGFR) testing rates in Ontario were also evaluated before and after the intervention period., Results: Ten programs were administered to diagnostic specialists, including respirologists, pathologists, thoracic surgeons, radiologists, radiation oncologists, and medical oncologists, with completion of 255 preintervention and 219 postintervention surveys. At baseline, 30% were unsure of tissue handling methods for molecular testing, 20% chose an incorrect technique, and half were unfamiliar with how to initiate testing. After intervention, specialist knowledge improved regarding tissue handling and appropriate fixation techniques and uncertainty decreased from 30% to 2% (p < 0.001). A 12% increase (relative increase 57%) in molecular (EGFR) testing requests in Ontario was observed over the intervention period (p = 0.0032)., Conclusions: Significant knowledge gaps exist among diagnostic specialists regarding molecular testing and targeted therapy in lung cancer. This initiative significantly improved understanding of the importance and methods of successful molecular testing and correlated with increased testing rates., (Copyright © 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Accessory ossicles are developmental variants which are often asymptomatic. When incidentally picked up on imaging, they are often inconsequential and rarely a cause for concern. However, they may cause pain or discomfort due to trauma, altered stress, and over-activity. Nuclear scintigraphy may play a role in the diagnosis and localizing pain generators. 18 F-Sodium Fluoride (NaF) is a PET imaging agent used in bone imaging. Although commonly used in imaging patients with cancer imaging malignancy, 18 F-NaF may be useful in the evaluation of benign bone and joint conditions. In this article, we would like to present a spectrum of clinical cases and review the potential diagnostic utility of 18 F-NaF in the assessment of symptomatic accessory ossicles in patients referred for staging cancers., Competing Interests: None.

This study examined the effect of carbohydrate (CHO) and protein (PRO) co-ingestion on energy substrate metabolism, sense of effort, and affective responses during prolonged strenuous endurance exercise. In a four-stage randomized cross-over design, 10 male endurance runners (age: 27.3±1.4yrs; height: 172.9±1.1cm, weight: 63.5±1.6kg; body fat: 9.0±1.4%; V̇O 2max : 62.9±1.8ml/kg/min) ran on a treadmill at 70% of their individual V̇O 2max for 90min. There were two CHO and PRO treatments (CA: CHO+alpha-lactalbumin and CW: CHO+whey PRO isolate), one CHO treatment (CC: CHO+CHO), and a placebo control (CON). On each occasion, subjects consumed 5ml/kg according to their body weight (kg) immediately before and 2ml/kg every 15min during exercise. Blood samples were collected at 0min, 30min, 60min and 90min of exercise to measure glucose, lactate, insulin, and cortisol levels. The extent of physical sensation (abdominal discomfort, leg muscle pain), the sense of effort (rating of perceive exertion, RPE), and affective responses (pleasure-displeasure, arousal) were evaluated by numeric scales before, during, and immediately after exercise. Blood glucose and insulin concentrations in the CA, CW, and CC treatments were higher than in the CON at 90min (P<0.05). Muscle pain (evaluated by a single item, 0 to 10 pain intensity scale from "no pain at all" to "extremely unbearable") was lower following CA ingestion than CON and CW ingestion, at 75min (vs. CON and CW, 1.95±0.61 vs. 3.70±1.00 and 3.60±1.02, P<0.05) and 90min (vs., Con & Cw: 2.40±0.76 vs. 4.20±0.99 and 4.05±1.1, P<0.05). RPE (evaluated by a 15-point, 6 to 20 rating scale ranging from "very, very light" to "very, very hard") following treatment with CA was lower than with CON and CW at 90min (vs. CON and CW: 11.30±1.14 vs. 14.20±1.30 and 13.30±1.24, P<0.05). Compared with CON and CW, CA enhanced the feeling of pleasure (evaluated by feeling scale from -5, "very bad" to +5, "very good") at 90min (vs. CON and CW, 2.20±0.67 vs. -0.30±0.94 and 0.20±0.91, P<0.05). Co-ingestion of CHO and alpha-lactalbumin protein attenuates muscle pain, and therefore alleviates the sense of effort and enhances affective responses during 90min of strenuous running at 70% V̇O 2max., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Although molecular testing has become standard in managing advanced nonsquamous non-small-cell lung cancer (nsclc), most patients undergo minimally invasive procedures, and the diagnostic tumour specimens available for testing are usually limited. A knowledge translation initiative to educate diagnostic specialists about sampling techniques and laboratory processes was undertaken to improve the uptake and application of molecular testing in advanced lung cancer., Methods: A multidisciplinary panel of physician experts including pathologists, respirologists, interventional thoracic radiologists, thoracic surgeons, medical oncologists, and radiation oncologists developed a specialty-specific education program, adapting international clinical guidelines to the local Ontario context. Expert recommendations from the program are reported here., Results: Panel experts agreed that specialists procuring samples for lung cancer diagnosis should choose biopsy techniques that maximize tumour cellularity, and that conservation strategies to maximize tissue for molecular testing should be used in tissue processing. The timeliness of molecular reporting can be improved by pathologist-initiated reflex testing upon confirmation of nonsquamous nsclc and by prompt transportation of specimens to designated molecular diagnostic centres. To coordinate timely molecular testing and optimal treatment, collaboration and communication between all clinicians involved in diagnosing patients with advanced lung cancer are mandatory., Conclusions: Knowledge transfer to diagnostic lung cancer specialists could potentially improve molecular testing and treatment for advanced lung cancer patients., Competing Interests: We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare the following interests: JCC reports personal fees and nonfinancial support from Pfizer, outside the submitted work. DMH reports personal fees from Pfizer and from Merck, outside the submitted work. SKR reports grants from AstraZeneca during the conduct of the study. REM reports personal fees from Boehringer Ingelheim, Eli Lilly, Pfizer, Novartis, AstraZeneca, and Roche, outside the submitted work. MST reports personal fees from Merck Canada, grants and personal fees from AstraZeneca, personal fees from Bristol–Myers Squibb, personal fees from Ventana Hoffmann–La Roche, and grants and personal fees from Pfizer Canada, outside the submitted work. NBL reports grants from the Ontario Institute of Cancer Research during the conduct of the study.

Herein we report a practical synthetic route to the lasso peptide lassomycin () and C-terminal variant lassomycin-amide (). The biological evaluation of peptides and against Mycobacterium tuberculosis revealed that neither had any activity against this bacterium. This lack of biological activity has led us to propose that naturally occurring lassomycin may actually exhibit a standard lasso peptide threaded conformation rather than the previously reported unthreaded structure.

Classic radiological and nuclear medicine signs have been reported extensively because of a myriad of pathophysiological processes. When encountered, they aid in diagnosis of conditions and add confidence for the reader, at times even hinting at a specific diagnosis. The naming of signs is commonly associated with objects from everyday life to establish familiarity with visual findings. Association of signs and disease comes with regular practice and improves understanding of the image and its underlying cause. In this article, we have collated nuclear medicine signs reported in the literature since 1970., (Copyright © 2015 Elsevier Inc. All rights reserved.)

1. Reliable and valid interviewer-administered questionnaires were developed to investigate associations of perceived neighbourhood attributes of Hong Kong older adults with their walking for transportation and recreation. 2. Access to and availability of different types of services and destinations, provision of facilities for resting/sitting in the neighbourhood, and easy access to/from residential buildings may help maintain an active lifestyle by facilitating walking for transport in the neighbourhood. 3. Access to services, indoor places for walking, environmental aesthetics, low traffic, and absence of physical barriers may promote recreational walking..

1. We assessed children's physical activity (PA) in structured (physical education) and unstructured (recess, lunch, before and after school) periods in special schools and examined its association with modifiable area contextual characteristics. 2. Children with disabilities were not highly active, but were more active during recess and lunch periods than at other times including physical education classes. 3. Areas were often not accessible during unstructured settings. Children were more active in areas when supervision and organised activities were provided. 4. Providing an interactive game during free play did not significantly increase group's PA. 5. Children's PA accrual is influenced by contextual characteristics of the school environment. There is a need to make areas more accessible and to use social marketing and programming to attract more users. School and health professionals should modify contextual characteristics by providing more direct supervision and organised activities during free play.

Background: Children with intellectual disabilities (ID) have been found to have inferior motor proficiencies in fundamental movement skills (FMS). This study examined the effects of training the FMS of overhand throwing by manipulating the amount of practice errors., Methods: Participants included 39 children with ID aged 4-11 years who were allocated into either an error-reduced (ER) training programme or a more typical programme in which errors were frequent (error-strewn, ES). Throwing movement form, throwing accuracy, and throwing frequency during free play were evaluated., Results: The ER programme improved movement form, and increased throwing activity during free play to a greater extent than the ES programme. Furthermore, ER learners were found to be capable of engaging in a secondary cognitive task while manifesting robust throwing accuracy performance., Conclusions: The findings support the use of movement skills training programmes that constrain practice errors in children with ID, suggesting that such approach results in improved performance and heightened movement engagement in free play., (© 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.)

Proficient fundamental movement skills (FMS) are believed to form the basis of more complex movement patterns in sports. This study examined the development of the FMS of overhand throwing in children through either an error-reduced (ER) or error-strewn (ES) training program. Students (n = 216), aged 8-12 years (M = 9.16, SD = 0.96), practiced overhand throwing in either a program that reduced errors during practice (ER) or one that was ES. ER program reduced errors by incrementally raising the task difficulty, while the ES program had an incremental lowering of task difficulty. Process-oriented assessment of throwing movement form (Test of Gross Motor Development-2) and product-oriented assessment of throwing accuracy (absolute error) were performed. Changes in performance were examined among children in the upper and lower quartiles of the pretest throwing accuracy scores. ER training participants showed greater gains in movement form and accuracy, and performed throwing more effectively with a concurrent secondary cognitive task. Movement form improved among girls, while throwing accuracy improved among children with low ability. Reduced performance errors in FMS training resulted in greater learning than a program that did not restrict errors. Reduced cognitive processing costs (effective dual-task performance) associated with such approach suggest its potential benefits for children with developmental conditions., (© 2011 John Wiley & Sons A/S.)

This study examined reliability and validity of the Chinese version of the International Physical Activity Questionnaire-Long Form (IPAQ-LC) in Chinese seniors, including moderating effects of neighborhood walkability and socioeconomic status (SES) on reliability and validity. The IPAQ-LC was interviewer-administered (n = 96), accelerometer and 7-day walk-diary data were collected (n = 94), and the IPAC-LC was readministered (N = 92). Acceptable reliability was found for all measures of physical activity (PA) overall and across different types of neighborhood. Participants from highly walkable neighborhoods were more reliable at estimating walking for transport. Participants from low-SES areas were less reliable at estimating leisure-time PA and sitting but more reliable at estimating transport-related walking. IPAQ-LC walking was significantly related to light- but not moderate-intensity accelerometry-based PA. It was moderately to strongly related to a 7-day diary of walking. The data imply slow-paced walking, probably due to age, climate, and terrain. The findings suggest that the IPAQ-LC's reliability and validity are acceptable in Chinese seniors.

Background: Chinese herbal medicine is increasingly widely used as a complementary approach for control of breast cancer recurrence and metastasis. In this paper, we examined the implicit prescription patterns behind the Chinese medicinal formulae, so as to explore the Chinese medicinal compatibility patterns or rules in the treatment or control of breast cancer recurrence and metastasis., Methods: This study was based on the herbs recorded in Pharmacopoeia of the People's Republic of China, and the literature sources from Chinese Journal Net and China Master Dissertations Full-text Database (1990 - 2010) to analyze the compatibility rule of the prescription. Each Chinese herb was listed according to the selected medicinal formulae and the added information was organized to establish a database. The frequency and the association rules of the prescription patterns were analyzed using the SPSS Clenmentine Data Mining System. An initial statistical analysis was carried out to categorize the herbs according to their medicinal types and dosage, natures, flavors, channel tropism, and functions. Based on the categorization, the frequencies of occurrence were computed., Results: The main prescriptive features from the selected formulae of the mining data are: (1) warm or cold herbs in the Five Properties category; sweet or bitter herbs in the Five Flavors category and with affinity to the liver meridian are the most frequently prescribed in the 96 medicinal formulae; (2) herbs with tonifying and replenishing, blood-activating and stasis-resolving, spleen-strengthening and dampness-resolving or heat-clearing and detoxicating functions that are frequently prescribed; (3) herbs with blood-tonifying, yin-tonifying, spleen-strengthening and dampness-resolving, heat-clearing and detoxicating, and blood-activating with stasis-resolving functions that are interrelated and prescribed in combination with qi-tonifying herbs., Conclusions: The results indicate that there is a close relationship between recurrence and metastasis of breast cancer with liver dysfunctions. These prescriptions focus on the herbs for nourishing the yin-blood, and emolliating and regulating the liver which seems to be the key element in the treatment process. Meanwhile, the use of qi-tonifying and spleen-strengthening herbs also forms the basis of prescription patterns.

Introduction: The need for up-to-date and high-quality continuing medical education (CME) is growing while the financial investment in CME is shrinking. Despite online technology's potential to efficiently deliver electronic CME (eCME) to large numbers of users, it has not yet displaced traditional CME. The purpose of this study was to explore what health care providers want in eCME and how they want to use it., Methods: This was a qualitative study. Two 3-hour focus groups were held with physicians in both academic and community practices as well as trainees knowledgeable in the hypertension clinical practice guidelines with a willingness to discuss eCME. Content/thematic analysis was used to examine the data., Results: Three main themes emerged: credibility, content/context, and control. Credibility was the most consistent and dominant theme. Affiliations with medical organizations and accreditation were suggested as methods by which eCME can gain credibility. The content and need for discussion of the content emerged as a key pivot point between eCME and traditional CME: a greater need for discussion was linked to a preference for traditional face-to-face CME. Control over the content and how it was accessed was an emergent theme, giving learners the ability to control the depth of learning and the time spent. They valued the ability to quickly find information that was in a format (podcast, video, mobile device) that best suited their learning needs or preferences at the time., Discussion: This study provides insight into physician preferences for eCME and hypotheses that can be used to guide further research., (Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.)

Background: Thrombophilic predisposition may be one of the underlying causes of recurrent miscariage (RM). The purpose of this study was to evaluate the Prothrombin G20210A mutation in cases with history of RM., Material and Methods: A total of 104 cases, 55 with diagnosis of RM and 49 control cases, were included in this controlled study. In all cases, in addition to full examination tests, Prothrombin 20210A mutation analysis was carried out by means of Polymerase Chain Reaction (PCR)., Results: Mean number of the abortion was 3.51 +/- 0.74 in the RM group and 0.08 +/- 0.27 in the control group (p < 0.05). As a consequence of comprehensive examinations, in 24 (43.6%) of 55 RM cases at least one etiologic factor was put forth. Prothrombin G20210A mutation was observed in six (10.9%) cases of the RM group and one (2.04%) in the control group (p < 0.05). Four of the six cases (66.7%) of Prothrombin G20210A mutation had a subsequent pregnancy. Among these four pregnancies, there was one spontaneous loss at 14 weeks of gestation and one severe pre-eclampsia., Conclusion: Our data together with literature suggest that Prothrombin G20210A mutation may be associated with RM. We recommend this genetic testing as a screening tool for women with history of RM.

Growth of China s infants and children has improved since the introduction of economic reforms. After 1979, secular increases in both weight and length have been observed. In certain industrial centers, infant lengths have caught up to international standards. Overall prevalence of underweight and stunting have declined. However, the health benefits from economic growth have not been shared equally among the Chinese population. There remain large disparities in the standard of health delivered to different sectors of the Chinese population. Rural children and children of minority nationalities continue to suffer from malnutrition and thus lower growth as compared to urban children. Economic reform has also changed the Chinese diet. Infant and child obesity is rising. Therefore, although economic reform has stimulated improvements in the growth of China s children, continued development and attention is needed in disadvantaged areas and populations. Public education is also necessary for China s children to avoid the diet-related diseases frequently seen in the west.

This paper describes the cost-benefit analysis of a computerized medical record system for use in physicians' offices. Actual data for savings in physician time in paper work was collected. The qualitative benefits of the system were evaluated using a questionnaire. The cost-benefit ratios demonstrated that the use of a computerized medical system is justified.