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In recent decades, researchers' interest in the role of emotions in individual political learning has grown. However, it is still unclear whether and how discrete emotions are associated with political learning. Through a cross-disciplinary systematic review and multilevel meta-analysis, we reviewed which discrete emotions have been analyzed in the context of political learning so far and meta-analytically synthesized how these emotions relate to political learning. We addressed this question by synthesizing associations between discrete emotions and various aspects of learning about political matters, such as political attention, information seeking, discussions, knowledge, and knowledge gain. The final dataset included 66 publications with 486 effect sizes, involving more than 100,000 participants. Most of the effect sizes were based on negative-activating emotions (65%; mainly anxiety, 32%, and anger, 19%) and positive-activating emotions (32%; mainly enthusiasm, 15%), while studies on positive-deactivating emotions (e.g., contentment) and negative-deactivating emotions (e.g., sadness) are largely lacking. We uncovered small positive associations (r = 0.05 to 0.13) for activating emotions, of both negative (especially anger) and positive valence (e.g., enthusiasm, only in cross-sectional designs), but no associations for negative-deactivating emotions. We discuss theoretical implications and recommend future research to include previously unconsidered emotions in order to extend existing findings.

Abstract Background We aimed to measure the effect of a 2-day structured paediatric simulation-based training (SBT) on basic and advanced airway management during simulated paediatric resuscitations. Methods Standardised paediatric high-fidelity SBT was conducted in 12 of the 15 children’s hospitals in Hesse, Germany. Before and after the SBT the study participants took part in two study scenarios (PRE and POST scenario), which were recorded using an audio–video system. Airway management was assessed using a performance evaluation checklist. Time to initiate ventilation, frequency, and timing of endotracheal intubation (ETI), and its influence on other life support interventions were assessed. Differences in airway management between hospitals with and without a PICU were evaluated. Results Two hundred twenty-nine participants formed 58 interprofessional resuscitation teams. All teams recognised apnoea in their simulated patients and initiated ventilation during the scenarios. Time to recognition of apnoea and time to initiation of ventilation did not improve significantly after SBT, but teams were significantly more likely to select appropriately sized airway equipment. ETI was attempted in 55% PRE and 40% POST scenarios (p=0.1). The duration of the entire ETI process was significantly shorter in the POST scenarios. Chest compressions (CC) were frequently discontinued during ETI attempts, which improved after SBT (PRE 73% vs. POST 43%, p = 0.035). Adequate resumption of CC after completion of intubation was also significantly more frequent in the POST scenarios (46% vs. 74%, p = 0.048). During ETI attempts, CC were more likely to be adequately continued in teams from hospitals with a PICU (PRE scenarios: PICU 20% vs. NON-PICU 36%; POST scenarios: PICU 79%, NON-PICU 22%; p

Abstract Background Mindfulness has been studied as a treatment option for a large range of psychological disorders and is associated with a multitude of positive psychological outcomes. There are now several scales for measuring mindfulness as both a trait and a state. As mindfulness potentially plays a critical role in maintaining physical activity habits, the State Mindfulness Scale for Physical Activity (SMS-PA) was developed to specifically measure mindfulness in a physical activity context. This study aimed to provide validity evidence for a German version of the SMS-PA (henceforth called SMS-PA-G) in a clinical sample. Methods We used baseline data from 129 participants in the randomised controlled trial ‘New Ways to Cope with Depression’. The sample, which was screened for clinical depression symptoms, completed the SMS-PA-G and several other psychometric scales for capturing state mindfulness, self-efficacy, sense of coherence, anxiety, depression, and physical activity. We conducted reliability and item analyses and ran a confirmatory factor analysis. Also, we assessed construct validity through correlations with the abovementioned scales and through differences in SMS-PA scores between physically active and nonactive participants. Results The mean SMS-PA-G score in our sample was 25.3 with a standard deviation of 8.5. The item and reliability analyses provided satisfactory Cronbach’s alpha and discriminatory power values. The confirmatory factor analysis showed that physical activity mindfulness can best be described via a bifactor model, with specific mind and body factors and a general mindfulness factor. We found the expected relationships with the attention subscale of state mindfulness, self-efficacy, and sense of coherence but did not find them with the awareness subscale of state mindfulness, depression, and anxiety. As hypothesised, physically active participants exhibited higher SMS-PA-G values than nonactive participants. Conclusions The SMS-PA-G is an internally consistent test instrument that captures respondents’ general physical activity mindfulness and their attention to mental and bodily events. Whereas validity evidence was generally supportive of the SMS-PA-G, its relationships with other constructs require further investigation. Trial registration ISRCTN, ISRCTN12347878. Registered 28 March 2022, https://www.isrctn.com/ISRCTN12347878 .

ABSTRACT Background Viral infections are established contributors to oncogenesis, leading to significant public health challenges. This systematic review aims to synthesize current knowledge on the mechanisms of viral cellular transformation and their association with various cancers. Recent findings Studies reveal key mechanisms of oncogenesis, including direct viral integration into the host genome, expression of viral oncogenes, and indirect pathways such as chronic inflammation and immune evasion. Notably, Human Papillomavirus (HPV) was linked predominantly to cervical and oropharyngeal cancers, while Epstein–Barr Virus (EBV) was associated with lymphomas. Hepatitis B and C viruses were linked to liver cancer, highlighting the diverse impacts of viral infections on oncogenic processes. Conclusions This review underscores the complexity of viral interactions with host cells and their implications for cancer development. Findings suggest that targeted interventions, such as vaccination and antiviral therapies, may play a crucial role in reducing the incidence of virus‐related cancers. Further research is needed to explore novel therapeutic strategies and the role of co‐factors in viral oncogenesis.

Objectives As a high-intensity intermittent sport with short and repeated rapid accelerations, decelerations and changes of direction, badminton involves high joint and muscle loads. This review aims to identify relevant injury risk characteristics and factors that facilitate developing and implementing badminton-specific injury prevention programmes.Design This systematic review of badminton injuries assessed the risk of bias, injury incidence, mechanism, location, type, severity, and risk factors.Data sources PubMed, WoS, SURF, EBSCO, Ovid and SPORTDiscus.Eligibility criteria Only English or German peer-reviewed articles presenting epidemiological data. All age groups, genders and levels of play were represented.Results Examination of 19 studies with male (60%) and female players (41%) at different player levels (age: 10–50 years). The mean injury incidence was between 1 and 4 injuries/1000 hours, whereby the incidence in the studies that were only carried out with elite players tended to be at the upper end. Lower body injuries occurred most frequently (41%–92%), including strains (11%–64%), sprains (10%–61%), tendinopathy (6%–14%) and stress fractures (5%–11%). There was a high proportion of overuse injuries (25%–74%) and a predominance of mild and moderate injuries (73%–100%). The following risk factors can only be cautiously emphasised due to the heterogeneous results: The risk of injury increases with increasing level of play and a history of injury.Conclusion Young players with a history of injury quickly moving to higher competition classes must be targeted with the highest injury prevention priority. Future studies should focus on improving the quality of studies by using comparable data collection methods.

Abstract Cosmological correlators, the natural observables of the primordial universe, have been extensively studied in the past two decades using the in-in formalism pioneered by Schwinger and Keldysh for the study of dissipative open systems. Ironically, most applications in cosmology have focused on non-dissipative closed systems. We show that, for non-dissipative systems, correlators can be equivalently computed using the in-out formalism with the familiar Feynman rules. In particular, the myriad of in-in propagators is reduced to a single (Feynman) time-ordered propagator and no sum over the labelling of vertices is required. In de Sitter spacetime, this requires extending the expanding Poincaré patch with a contracting patch, which prepares the bra from the future. Our results are valid for fields of any mass and spin but assuming the absence of infrared divergences. We present three applications of the in-out formalism: a representation of correlators in terms of a sum over residues of Feynman propagators in the energy-momentum domain; an algebraic recursion relation that computes Minkowski correlators in terms of lower order ones; and the derivation of cutting rules from Veltman’s largest time equation, which we explicitly develop and exemplify for two-vertex diagrams to all loop orders. The in-out formalism leads to a natural definition of a de Sitter scattering matrix, which we discuss in simple examples. Remarkably, we show that our scattering matrix satisfies the standard optical theorem and the positivity that follows from it in the forward limit.

This paper delves into the analysis of card fraud within the banking system. Its aim is to gain a comprehensive understanding of fraud in the banking sector and explore effective detection techniques. The paper examines advanced techniques such as data analysis, automatic learning algorithms, and real-time monitoring systems to detect suspicious patterns, anomalies, and deviations from normal behavior with precision. To achieve this, the research methodology employs a combination of qualitative and quantitative analysis. Furthermore, empirical research is conducted to evaluate the effectiveness of Machine Learning-based decision tree algorithms in identifying card fraud using real-world datasets. By understanding the nature of fraud and implementing robust detection methods, banks can safeguard their operations, assets, and customers, and uphold trust in the banking system.

PurposeHigh-intensity functional interval training (HIFT) is predominantly composed of high exercise training intensities (HiT) and loads. Both have been linked to a higher risk of overtraining and injuries in inexperienced populations. A polarized training approach is characterized by high amounts of low-intensity training (LiT) and only approximately 5%–20% HiT. Compared to HIT-based training, this approach can result in temporary training load and intensity reductions without diminishing training gains. Thus, we aimed to examine the effects of traditional (TRAD) HIFT vs. polarized (POL) HIFT on relevant performance parameters.MethodsThirty athletes (15 females, age: 26.6 ± 5.0 years, height: 1.76 ± 0.13 m, body mass: 79.6 ± 12.4 kg, prior experience: 2.3 ± 2.0 years, training volume: 6.1 ± 2.4 h/wk) were randomly assigned to 6 weeks of either POL (78% LiT, 22% threshold intensity training (ThT) to HiT) or TRAD (26% LiT, 74% ThT to HiT). HIFT performance testing focused on maximal strength (squat: SQ1RM, deadlift: DL1RM, overhead press: OHP1RM, high pull: HP1RM), endurance (peak oxygen uptake: V̇O2peak, lactate threshold: LT, peak power output (PPO), and benchmark HIFT workout (Jackie: 1000 m rowing, 50 thrusters, and 30 pull-ups for time).ResultsPOL (785 ± 71 au) completed significantly (p ≤ 0.001; SMD = 4.55) lower training load (eTRIMP) than TRAD (1,273 ± 126 au). rANCOVA revealed no statistical relevant group×time interaction effects (0.094 ≤ p ≤ 0.986; 0.00 ≤ ηp2 ≤ 0.09) for SQ1RM, DL1RM, OHP1RM, high pull, V̇O2peak, LT, PPO, and Jackie performance. Both groups revealed trivial to moderate but significant (rANCOVA time effects: p ≤ 0.02; 0.01 ≤ ηp2 ≤ 0.11; 0.00 ≤ SMD ≤ 0.65) performance gains regarding DL1RM, OHP1RM, HP1RM, and Jackie.ConclusionDespite a notably lower total training load, conditioning gains were not affected by a polarized functional interval training regimen.

Type 1 diabetes (T1D) is an autoimmune disease characterized by the destruction of insulin-producing β-cells in the pancreas. This destruction leads to chronic hyperglycemia, necessitating lifelong insulin therapy to manage blood glucose levels. Typically diagnosed in children and young adults, T1D can, however, occur at any age. Ongoing research aims to uncover the precise mechanisms underlying T1D and to develop potential interventions. These include efforts to modulate the immune system, regenerate β-cells, and create advanced insulin delivery systems. Emerging therapies, such as closed-loop insulin pumps, stem cell-derived β-cell replacement and disease-modifying therapies (DMTs), offer hope for improving the quality of life for individuals with T1D and potentially moving towards a cure. Currently, there are no disease-modifying therapies approved for stage 3 T1D. Preserving β-cell function in stage 3 T1D is associated with better clinical outcomes, including lower HbA1c and decreased risk of hypoglycemia, neuropathy, and retinopathy. Tumor Necrosis Factor alpha (TNF-α) inhibitors have demonstrated efficacy at preserving β-cell function by measurement of C-peptide in two clinical trials in people with stage 3 T1D. However, TNF-α inhibitors have yet to be evaluated in a pivotal trial for T1D. To address the promising clinical findings of TNF-α inhibitors in T1D, Breakthrough T1D convened a panel of key opinion leaders (KOLs) in the field. The workshop aimed to outline an optimal clinical path for moving TNF-α inhibitors to a pivotal clinical trial in T1D. Here, we summarize the evidence for the beneficial use of TNF-α inhibitors in T1D and considerations for strategies collectively identified to advance TNF-α inhibitors beyond phase 2 clinical studies for stage 3 T1D.

The decision of the Union Internationale de Pentathlon Moderne to replace horse riding with Obstacle after the 2024 Olympic Games challenges training, testing, and recovery management in Modern Pentathlon. This commentary discusses physiological, technical, and tactical effects of rule changes in the 5 disciplines with a specific focus on the new discipline Obstacle. Modern Pentathlon requires athletes to develop specific endurance capacities relying on both the aerobic and anaerobic systems while simultaneously increasing lower- and upper-body strength capabilities. In addition, movements must be repeatedly executed in an explosive and precise manner. Running and swimming must be fast but economical. Swapping from horse riding to Obstacle will prioritize the explosive strength of the upper extremities and core while keeping high levels of endurance and precision in swimming, fencing, and shooting. Moreover, condensing the Modern Pentathlon competition to a 90-minute television-friendly format enables more competitions in the future. Athletes and coaches will thus also need to develop and maintain effective individual peri-exercise routines (before, during, and after the competition) to successfully meet the resulting tactical and physical challenges of the new format. This commentary aims to stimulate the discussion on the effect of the Union Internationale de Pentathlon Moderne's decisions to replace riding with the new Obstacle discipline and implement a more television-friendly format with a focus on physiological, technical, and tactical aspects. [ABSTRACT FROM AUTHOR]

To mitigate carbon emissions, energy systems around the world are electrified using renewable energy. In California, the leading renewable source is photovoltaic, which is intermittent and requires storage technology not yet deployed on a broad scale to sufficiently meet demand. To utilize its great offshore wind resource potential that can counterbalance solar and thus contribute to a stable and green energy mix in the future, floating turbines deployable in deep waters are needed as the Californian steep shelf falls off quickly. The sector, currently emerging globally, represents a high-risk investment market where costs exceed benefits. The paper finds that direct subsidies as provided through strike prices agreed upon in auction systems between governments of Europe's leading offshore wind countries and developers over the last ten years ensuring fixed rates for future electricity production can support the economic viability of projects offshore the densely populated south.Evaluating three potential sites, the Southern California Offshore Wind model accounts for location-specific data input as well as findings from analyses conducted by the National Renewable Energy Laboratory. Based on the model, scenario analyses are conducted to consider the impact of technical progress and learning as well as carbon mitigation policies (carbon price and direct subsidy) on costs and benefits calculating the net value for deployment dates in 2022, 2027, and 2032.The results show that all three sites are unprofitable considering direct costs and benefits only although net values develop positively with the advancement of the industry. Supported by the highest carbon price as of April 2020 – Swedish carbon tax: $119/tCO2e – one site becomes profitable from 2027 onward. In contrast, taking adjusted EU strike prices for fixed-bottom systems into account, enables two sites to become economically viable in 2022 and 2027 but not in 2032. As floating systems are more expensive, it can be assumed that prices for this technology would be higher.The paper concludes that, considering direct government support through an auction system can incentivize investments in a high-risk floating offshore wind sector, helping it to emerge in Southern California over the next ten years. With it, a stable and renewable energy supply for a growing demand can be ensured as offshore wind counterbalances solar as a complementary energy source peaking during different times of the day and providing power more constantly overall.

IntroductionMajor depressive disorders (MDD) are a leading health concern worldwide. While first line medication treatments may fall short of desired therapeutic outcomes, physical activity (PA) interventions appear to be a promising and cost-effective add-on to improve symptoms of depression. This study aimed to address challenges in the assessment of PA in inpatients treated for MDD by examining the correspondence of self-reported and accelerometer-based PA.MethodsIn 178 inpatients treated for MDD (mean age: M = 41.11 years, SD = 12.84; 45.5% female) and 97 non-depressed controls (mean age: M = 35.24 years, SD = 13.40; 36.1% female), we assessed self-reported PA via the Simple Physical Activity Questionnaire (SIMPAQ) for one week, followed by a week where PA was monitored using an accelerometer device (Actigraph wGT3x-BT). Additionally, we examined correlations between PA levels assessed with the SIMPAQ and exercise determinants in both groups.ResultsDescriptively, inpatients treated for MDD showed lower levels of light PA on accelerometer-based measures, whereas they self-reported increased levels of certain types of PA on the SIMPAQ. More importantly, there was only a small degree of correspondence between self-reported and actigraphy-based PA levels in both in patients (r = 0.15, p

IntroductionChronic low-grade inflammation might contribute to hyperandrogenemia and metabolic complications in polycystic ovary syndrome (PCOS). The proinflammatory cytokine interleukin (IL)-1 stimulates androgen production from ovarian cells, whereas blockade of the IL-1 pathway improves cardiometabolic health. We aimed to investigate whether blocking the IL-1 pathway ameliorates hyperandrogenemia in patients with PCOS.MethodsThis is a prospective, interventional, single-arm, proof-of-concept trial performed at a tertiary hospital in Switzerland (August 2018 to July 2020) in 18 premenopausal women with a diagnosis of PCOS according to the Rotterdam criteria, total testosterone levels ≥ 1.7 nmol/L, and C-reactive protein (CRP) ≥ 1.0 mg/L. Patients received 100 mg/day of the IL-1-receptor antagonist anakinra for 28 days and underwent weekly blood sampling until 1 week after the end of treatment. The primary endpoint was the change in serum androstenedione levels on day 7 of treatment, assessed with liquid chromatography–tandem mass spectrometry. Seven of these women participated in a subsequent observational sub-study (May 2021 to December 2021).ResultsMedian [interquartile range (IQR)] androstenedione increased by 0.5 [−0.1, 1.6] nmol/L (p = 0.048) with anakinra and by 1.3 [0.08, 2.4] nmol/L [p = 0.38] without anakinra between baseline and day 7. Anakinra reduced CRP levels on days 7, 21, and 28 (p < 0.001) but did not lead to an absolute reduction in androgens. However, four of six patients (67%) had smaller areas under the curves for androstenedione and/or testosterone during the 28-day intervention with anakinra as compared to 28 days without treatment.DiscussionOur findings suggest that anakinra suppresses IL-1-mediated chronic low-grade inflammation in PCOS and might attenuate biochemical hyperandrogenemia.

Ataxia telangiectasia (AT) is a rare autosomal-recessive disorder characterized by profound neurodegeneration, combined immunodeficiency, and an increased risk for malignant diseases. Treatment options for AT are limited, and the long-term survival prognosis for patients remains grim, primarily due to the emergence of chronic respiratory pathologies, malignancies, and neurological complications. Understanding the dysregulation of the immune system in AT is fundamental for the development of novel treatment strategies. In this context, we performed a retrospective longitudinal immunemonitoring of lymphocyte subset distribution in a cohort of AT patients (n = 65). Furthermore, we performed FACS analyses of peripheral blood mononuclear cells from a subgroup of 12 AT patients to examine NK and T cells for the expression of activating and functional markers. We observed reduced levels of peripheral blood CD3+CD8+ cytotoxic T cells, CD3+CD4+ T helper cells, and CD19+ B cells, whereas the amount of CD3−-CD56+ NK cells and CD3+CD56+ NKT-like cells was similar compared with age-matched controls. Notably, there was no association between the age-dependent kinetic of T-, B-, or NK-cell counts and the occurrence of malignancy in AT patients. Additionally, our results indicate an altered NK- and T-cell response to cytokine stimulation in AT with increased levels of TRAIL, FasL, and CD16 expression in NK cells, as well as an elevated activation level of T cells in AT with notably higher expression levels of IFN-γ, CD107a, TRAIL, and FasL. Together, these findings imply function alterations in AT lymphocytes, specifically in T and NK cells, shedding light on potential pathways for innovative therapies.

Introduction: Post-activation performance enhancement (PAPE) cannot be clearly distinguished from and may be explained in large by warm-up effects. To disentangle PAPE from a systemic warm-up effect, we conducted three randomized crossover trials (RCT).Methods: Each RCT consisted of a familiarization/one-repetition-maximum (1RM) assessment session followed by two interventional sessions (random order). In Study I, 18 participants (age: 26 ± 4 years; height: 1.84 ± 0.06 m; mass: 83.7 ± 8.7 kg; Squat-1RM: 146 ± 19 kg) performed either a 3-s isometric squat at 130%1RM or a 6-s isometric squat at 65%1RM. In Study II, 28 participants (11 female; age: 23 ± 3 years; height: 1.77 ± 0.08 m; mass: 76.5 ± 10.4 kg; Squat-1RM: 109 ± 38 kg) completed either Squat (3 × 3 repetitions, 85%1RM) or local electromyostimulation of the quadriceps muscle (85% of individual pain threshold). In Study III, 20 participants (6 female, age: 25.0 ± 3.5 years, mass: 78.5 ± 15.8 kg, height: 1.75 ± 0.08 m; SQ-1RM: 114 ± 33 kg, chest-press-1RM: 74 ± 29 kg) performed either squats or chest press (4 repetitions, 80%1RM). Counter-Movement-Jump height (CMJ) was assessed after a general (PRE) and/or muscle-specific warm-up (POST_WU) and for up to 11 min after the PAPE protocols. To identify possible differences in CMJ between the experimental conditions, mixed-design ANOVA models were used for each study individually, with condition and time modelled as fixed effects, while participants were included as a random effect blocking factor. The level of statistical significance was set at α = 5%.Results: In studies I and II, significant effects for time (p < 0.05, ωp2 = 0.06 and p < 0.001, ωp2 = 0.43) were found with the highest CMJ compared to all other time points at PRE (≤8.2 ± 4.6%, standardized mean difference: ≤0.39), regardless of condition. In study III, no significant effects were observed.Discussion: Thus, PAPE protocols do not further improve jumping performance compared to a general and muscle-specific traditional warm-up. Prior to tasks requiring explosive strength, general and sport-specific warm-up strategies should be used.

Chronic low back disorders are the leading cause of direct and indirect healthcare burden globally. Exercise training improves pain intensity, mental health and physical function. However, the optimal prescription variables are unknown. We aim to compare the efficacy of various exercise dosages for chronic low back disorders to identify the optimal prescription variables. Six databases (Medline, SPORTDiscus, CINAHL, PsycINFO, EMBASE and CENTRAL), trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) and reference lists of prior systematic reviews will be searched, and we will conduct forward and backward citation tracking. We will include peer-reviewed randomised controlled trials (individual, cluster or cross-over trials) published in English or German language comparing exercise training to other exercise training or non-exercise training interventions (conservative, non-surgical, non-pharmacological, non-invasive treatments, placebo, sham, usual/standard care, no-treatment control, waitlist control) in adults with chronic low back disorders. Outcomes will include pain intensity, disability, mental health, adverse events, adherence rate, dropout rate and work capacity. Version 2 of the Cochrane risk-of-bias tool will be employed. The dose will be categorised as cumulative dose (total and weekly minutes of exercise training) and individual dose prescription variables (intervention duration, session duration, frequency and intensity). Dose-response model-based network meta-analysis will be used to assess the comparative efficacy of different exercise doses to determine a dose–response relationship. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation. Information about optimal exercise training dosage will help in enhancing treatment outcomes.

Objectives Most children with uncomplicated urinary tract infections (UTI) can be managed with oral antibiotics. However, identifying those likely to fail oral and need intravenous antibiotics due to complicating features at presentation is challenging. We aimed to derive, validate and test a score to guide initial antibiotic route.Design This cohort study enrolled children both prospectively and retrospectively. Patients were divided into two groups based on whether they received intravenous or oral antibiotics after 24 hours, including those who switched between routes. Children diagnosed with confirmed UTI were used to derive then validate the score, comparing complicating clinical features between the two groups. Combinations of significantly differentiating features generated receiver operating characteristic curves and the optimal cut-off for intravenous antibiotic use was selected.Setting The emergency department of a tertiary paediatric hospital.Participants All children aged 3 months–17 years with suspected UTI were eligible, and were included if they fulfilled the diagnostic criteria for UTI.Outcome measures The effectiveness of the derived clinical score to differentiate patients at presentation who had complicated UTI requiring ongoing intravenous antibiotics.Results There were 1240 patients, of whom 167 children aged 12 months–11 years with confirmed UTI comprised the derivation cohort. The combination of features that performed optimally (area under curve 0.85, 95% CI 0.79 to 0.91) were: rigors, urological abnormality, pyrexia (≥38°C), emesis, recurrent (≥3) UTI, tachycardia: the RUPERT score (1 point each, maximum 6). A score ≥3 accurately classified route of antibiotics after 24 hours for 80% patients (sensitivity 77%, specificity 81%). For the 168 patients in the validation cohort, the score accurately classified 76% (sensitivity 67%, specificity 78%). The score tested well in ‘probable’ UTI and adolescents, and less well in infants.Conclusion The Melbourne RUPERT score provides the first standardised, easy-to-use score to aid clinicians in deciding route of antibiotics for more complicated UTI in children. It now needs prospective validation.