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This document discusses the refinement and evaluation of the Gross Motor Family Report (GM-FR), a tool used to assess gross motor function in children and adolescents with cerebral palsy. The study involved input from families to ensure the content validity of the measure. The GM-FR demonstrated high internal consistency and test-retest reliability. It also showed strong concurrent validity with other measures of gross motor function. The findings suggest that the GM-FR is a reliable and valid tool for assessing gross motor activity in children with cerebral palsy. [Extracted from the article]

Aim Method Results Interpretation To refine the Gross Motor Family Report (GM‐FR) using parents' input and to evaluate its psychometric properties.In this measurement study, 12 parents of children and adolescents with cerebral palsy (CP), aged 2 to 18 years, classified in all levels of the Gross Motor Function Classification System (GMFCS), were interviewed about their experience completing the GM‐FR (content validity). Parents' feedback was used to refine the measure which was then completed by 146 families to evaluate internal consistency, and discriminative and concurrent validity. Forty‐six parents completed the GM‐FR again, 7 to 30 days later, to evaluate test–retest reliability.GM‐FR scoring, pictures, descriptions, and the total number of items were revised based on parents' feedback. The GM‐FR version 2.0 demonstrated high internal consistency (Cronbach's α = 0.99), no floor/ceiling effects, and excellent test–retest reliability (intraclass correlation coefficient = 0.99). GM‐FR scores discriminated between GMFCS levels (p < 0.05) and were strongly negatively correlated with GMFCS level (r = −0.92; p < 0.001). GM‐FR scores correlated positively and strongly with the Gross Motor Function Measure‐66 (r = 0.94; p < 0.001) and the Pediatric Evaluation of Disability Inventory – Computer Adaptive Test mobility domain (r = 0.93; p < 0.001).Active participation of families in the GM‐FR's development facilitated creation of a family‐friendly instrument. This study provides strong evidence of reliability and validity to support GM‐FR use in clinical practice and research for assessing gross motor performance of children and adolescents with CP. [ABSTRACT FROM AUTHOR]

Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine physical activity levels and influencing individual and environmental factors in a group of adolescent survivors of cancer and a comparison group. Methods. The study was conducted using a "mixed methods" design. Quantitative data was collected from 48 adolescent survivors of cancer and 48 comparison adolescents using the Godin Leisure-Time ExerciseQuestionnaire, the Fatigue Scale--Adolescents, and theAmherstHealth andActivity Study--Student Survey. Qualitative data was collected in individual semistructured interviews. Results. Reported leisure-time physical activity total scores were not significantly different between groups. Physical activity levels were positively correlated with adult social support factors in the group of adolescent survivors of cancer, but not in the comparison group. Time was the primary barrier to physical activity in both groups. Fatigue scores were higher for the comparison but were not associated with physical activity levels in either group. The qualitative data further supported these findings. Conclusions. Barriers to physical activity were common between adolescent survivors of cancer and a comparative group. Increased knowledge of the motivators and barriers to physical activity may help health care providers and families provide more effective health promotion strategies to adolescent survivors of pediatric cancer. [ABSTRACT FROM AUTHOR]

This study describes the performance of children 8-11 years of age on the Community Balance and Mobility Scale (CB&M) and associations between performance and age, body mass index (BMI), and sex. A convenience sample of 84 was recruited. The CB&M was administered using instructions we developed for children. Mean CB&M total scores (95% confidence intervals) for age groups were 8: 70.1 (64.2, 76.1); 9: 72.8 (68.7, 76.8); 10: 79.2 (76.6, 81.7); and 11: 82.9 (79.2, 86.5). None of the children achieved the maximum score. Scores increased with age, and overweight/obese children had relatively lower scores. There were no significant differences between males and females. A regression analysis found 28.1% of the variation in the CB&M total scores was explained by age ( p < .001), BMI ( p < .01), and sex ( p = .25) suggesting that other factors contribute to variation in balance and mobility proficiency. The modified instructions and scoring patterns from this study can assist in using the CB&M in children of ages 8-11 years. [ABSTRACT FROM AUTHOR]

The article offers information on the timing and content of communication related to ventilatory support decisions for people with Duchenne muscular dystrophy (DMD). It states that respiratory failure is the most common cause of death in DMD, which occurs during benign upper respiratory tract infections. It mentions that the stress related to the psychosocial problems in children, may exceed its association with the physical aspects of the disease.

Objective: To describe distributions of contracture and spinal malalignment in adolescents with cerebral palsy (CP) and determine associations with age, gender and function. Methods: Data were collected using the Spinal Alignment and Range of Motion Measure (SAROMM), the Gross Motor Function Classification System (GMFCS) and the Activity Scale for Kids (ASK). Results: Two hundred and twenty-five adolescents (122 males; mean age 14 years 8 months; SD 1 year 8 months) participated. SAROMM scores by GMFCS levels and item scores in various body regions are presented. Correlations between indices of function and SAROMM total score were >0.70 ( p<0.001). Males in GMFCS levels I/V obtained higher total SAROMM scores than females. Age was significantly associated with SAROMM scores for GMFCS levels IV/V participants. Conclusions: These data provide benchmarks for evaluating impairments in adolescents with CP and support the role of function in contracture development and possibly prevention. Gender and age were factors that modified outcomes. [ABSTRACT FROM AUTHOR]

This commentary is on the systematic review by Tedroff et al. on pages 554–562 of this issue. [ABSTRACT FROM AUTHOR]

Sleep has a significant impact on the daily functioning of children and their parents. The purpose of this study was to describe the sleep patterns, issues, and strategies used to facilitate sleep in children with and without physical disabilities and their families. Data were collected from questionnaires completed by caregivers and siblings. Caregivers of children with physical disabilities reported significantly greater concerns regarding general sleep problems, safety, and discomfort at night, night wakening, daytime irritability, interference with daytime activities and sleep-related health concerns in children with physical disabilities than in their counterparts. Caregivers, but not siblings, in families of children with physical disabilities experienced an increased prevalence of sleep issues. The most frequently cited strategies to alleviate problems were the establishment of consistent routines and provision of calming, supportive sleep environments. Pediatric therapists need to assess and address sleep issues to promote the well-being of children and their families. [ABSTRACT FROM AUTHOR]

Background and Purpose. As the survival rate for acute lymphoblastic leukemia (ALL) in childhood increases, long-term sequelae are a growing concern. This cross-sectional, descriptive study compared the balance skills of children and youth who have had ALL with those of comparable subjects and explored associations with demographics, therapy, physical activity, and health-related quality of life (HRQL). Subjects. Ninety-nine subjects treated previously for ALL and 89 comparison subjects were examined. Methods. Measures included the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) balance subtest, the Children's Self-perceptions of Adequacy in and Predilection for Physical Activity Scale (CSAPPA), and the Health Utilities Index (HUI), a measure of HRQL. Results. The children and youth who had ALL had poorer balance than the comparison subjects (BOTMP = 10.55 and 16.30, respectively) and lower CSAPPA scores (57.72 and 63.72, respectively) and HUI scores (0.86 and 0.97, respectively). Regression analyses identified exposure to cranial irradiation, being overweight, lower CSAPPA scores for adequacy, and lower HUI single-attribute scores for cognition as predictors of lower balance scores in subjects who had ALL. Discussion and Conclusion. Balance abilities in subjects treated for ALL were compromised, and several factors were associated with this deficit. [ABSTRACT FROM AUTHOR]

Survivors of acute lymphoblastic leukemia (ALL) in childhood have been identified with balance problems. The goals of this study were to objectively quantify these observations by measuring the displacement and velocity of the body centre of pressure, a measure of ‘sway’. The subjects included 79 ALL survivors who were at least 1 year post-treatment for ALL and 83 age-matched controls. Testing was carried out using various static balance tests designed to challenge central nervous system maintenance of balance and postural control. Patients were different from controls, across all age groups, in the more difficult task in which they were required to balance over a narrow base of support. However this did not reach statistical significance. When they were asked to perform this task with their eyes closed 32% of the patients tested, as opposed to 2% of controls, were unable to complete the task (significant at P<0.01, χ2). The youngest group of patients (children aged 5–7 years) presented consistently with lower (or similar) displacement and lower velocity measures. This phenomenon has been observed in healthy children, however, in patients, these trends were magnified and beyond the normal age range in healthy children. The velocity values were significantly different from the other patient groups (normalized values for velocity; P<0.01). These observations then manifested as higher sway values when patients were challenged with a difficult task with their eyes closed. We propose that survivors of childhood ALL have delayed motor development compared to age-matched controls giving rise to impairment in balance and postural control. It is possible that these impairments are a consequence of intensive multi-agent chemotherapy and cranial irradiation. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to examine the effects of high-iron and low-vitamin E diets on lipid peroxidation and aberrant crypt foci (ACF) development in rats. In a 2 x 2 x 2 factorial design, male Sprague-Dawley rats were fed 45 or 450 mg Fe/kg diet (adequate and high iron, respectively) and 15 or 100 IU vitamin E/kg diet (low and adequate vitamin E, respectively)for three weeks, when they received saline or azoxymethane (15 mg/kg for 2 wk). Diets were continued for an additional six weeks. Serum a-tocopherol concentrations in rats fed tow-vitamin E diets were decreased to 30% of concentrations observed in rats fed adequate-vitamin E diets (p < 0.0001). Also, serum a-tocopherol concentrations tended to be lower in rats supplemented with iron (p < 0.08). Lipid peroxidation in liver was significantly elevated by high-iron diets after 3 and 10 weeks of treatment, but lipid peroxidation in colonic mucosa was not altered by dietary iron or vitamin E. The total number of ACF and number of large ACF (>/=4 aberrant crypts/focus) were not significantly altered by iron or vitamin E intakes. However, the size distribution of ACF was slightly altered, such that iron-supplemented rats had 12% more ACF with two cryptsper focus (p < 0.02) than rats fed adequate-iron diets. Our data suggest that high-iron diets enhanced oxidative stress in liver, but not colon, of rats fed low-vitamin E diets. Furthermore, a high-iron diet does not increase the total number of ACF, even when vitamin E status is low. [ABSTRACT FROM AUTHOR]

Simple Summary: Understanding the degree to which human interaction may alter natural animal behavior has become increasingly important in developing effective conservation strategies. We examined two populations of northern goshawks (Accipiter gentilis) in Montana and Finland. Goshawks in Finland were not protected until the late 1980s, and prior to this protection were routinely shot, as it was believed that shooting goshawks would keep grouse populations high. In the United States, Goshawk were not shot as a management strategy. Though aggressive nest defense has been characterized throughout North America, goshawks in Finland do not show this same behavior. To quantify aggression, we presented nesting goshawks with an owl decoy, a human mannequin, and a live human and recorded their responses to each of the trial conditions. We used statistics to compare the two populations. Our results suggested that goshawks in Montana exhibit more aggressive nest defense behaviors than those in Finland. While this could be due to some biotic or abiotic factor that we were not able to control for in a study on such a small scale, it is also possible that the results from this study suggest another underlying cause, such as an artificial selection pressure created by shooting goshawks. As human impacts on wildlife have become a topic of increasing interest, studies have focused on issues such as overexploitation and habitat loss. However, little research has examined potential anthropogenic impacts on animal behavior. Understanding the degree to which human interaction may alter natural animal behavior has become increasingly important in developing effective conservation strategies. We examined two populations of northern goshawks (Accipiter gentilis) in Montana and Finland. Goshawks in Finland were not protected until the late 1980s, and prior to this protection were routinely shot, as it was believed that shooting goshawks would keep grouse populations high. In the United States, Goshawk were not managed as predator control. Though aggressive nest defense has been characterized throughout North America, goshawks in Finland do not show this same behavior. To quantify aggression, we presented nesting goshawks with an owl decoy, a human mannequin, and a live human and recorded their responses to each of the trial conditions. We evaluated the recordings for time of response, duration of response, whether or not an active stimulus was present to elicit the response (i.e., movement or sound), and the sex of the bird making the response. We used t-Test with unequal variance to compare mean number of responses and response duration. Our results suggested that goshawks in Montana exhibit more aggressive nest defense behaviors than those in Finland. While this could be due to some biotic or abiotic factor that we were not able to control for in a study on such a small scale, it is also possible that the results from this study suggest another underlying cause, such as an artificial selection pressure created by shooting goshawks. [ABSTRACT FROM AUTHOR]

Although substantial progress has been made in the diagnosis and treatment of acute coronary syndromes, cardiovascular disease remains the leading cause of death globally, with nearly half of these deaths due to ischaemic heart disease. The broadening availability of high-sensitivity troponin assays has allowed for rapid rule-out algorithms in patients with suspected non-ST-segment elevated myocardial infarction (NSTEMI). Dual antiplatelet therapy is recommended for 12 months following an acute coronary syndrome in most patients, and additional secondary prevention measures including intensive lipid-lowering therapy (LDL-C <1·4 mmol/L), neurohormonal agents, and lifestyle modification, are crucial. The scientific evidence for diagnosis and management of acute coronary syndromes continues to evolve rapidly, including adapting to the COVID-19 pandemic, which has impacted all aspects of care. This Seminar provides a clinically relevant overview of the pathobiology, diagnosis, and management of acute coronary syndromes, and describes key scientific advances. [ABSTRACT FROM AUTHOR]

Aims:To engage researchers and knowledge-users in six Ontario communities in knowledge translation initiatives to identify community-informed elements to guide the development of an optimal physical activity program for youth with cerebral palsy (CP) and to support research efforts.Methods:The project included three iterative steps, i.e., an environmental scan of five communities, six regional planning meetings, and a member-checking survey, followed by a Delphi survey to reach consensus on the elements deemed most important.Results:Twenty-four elements were identified to include in programs promoting physical activity in youth with CP, which were organized in five categories: raise awareness of the options and opportunities (n= 4); pique interest and motivate youth to become and stay active (n= 9); ensure community programs are ready for youth with a disability (n= 2); be fit, fit in, and finding the best fit (n= 5); and explore the layers of physical activity and how they interact (n= 4).Conclusions:The 24 elements established characterize the key concepts that families and community stakeholders value when developing physical activity programs for youth with CP. When incorporated into clinical practice, each of the elements may be used to evaluate key aspects of outcome for individuals with CP. [ABSTRACT FROM PUBLISHER]

Youth with cerebral palsy (CP) face significant barriers to participation in physical activity (PA). There is little information available about the nature of these barriers. Seventeen (17) youth and/or their parents participated in focus groups and individual interviews to identify factors that make it easy or hard to be physically active. Four themes emerged across functional levels: environmental and personal factors, limitations related to impairment in body structure and function, the perception that health benefits alone do not motivate youth to be physically active, and variable preferences for activity delivery. Dialogue with participants revealed that interventions to promote PA in youth should mitigate the interactions between personal and environmental factors that act as barriers to PA, and enhance the interactions that facilitate PA. Partnerships between researchers, policy makers, service providers, and families must be developed to address system barriers and build capacity in youth with CP and their communities. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia has been established as a well-known traditional risk factor for cardiovascular disease in chronic kidney disease patients. Aim: This study investigated the impact of Hatha yoga exercise on lipid parameters in patients with end-stage renal disease (ESRD) on hemodialysis. Materials and Methods: This prospective randomized study consisted of 33 ESRD patients in the Hatha yoga exercise group that was matched with 35 ESRD patients in the control group. Serum total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol were determined at baseline (0 month) and after 4 months. Results: Comparing values after 4 months versus baseline in the prehemodialysis Hatha yoga exercise group, there was found a significant decrease in total cholesterol from 5.126 ± 0.092 mmol/l to 4.891 ± 0.072 mmol/l (-4.58%; P = 0.0001), triglycerides from 2.699 ± 0.078 mmol/l to 2.530 ± 0.063 mmol/l (-6.26%; P = 0.0001), LDL-cholesterol from 2.729 ± 0.083 mmol/l to 2.420 ± 0.066 mmol/l (-11.32%; P = 0.0001), and total cholesterol/HDL-cholesterol ratio from 5.593 ± 0.119 mmol/l to 4.907 ± 0.116 mmol/l (-12.26%; P = 0.047). For patients in the Hatha yoga exercise group, 51.5% had normal total cholesterol at 0 month while 70.0% had normal total cholesterol (P < 0.05) after 4 four months and 54.5% of patients had normal LDL-cholesterol at 0 month while 84.9% had normal LDL-cholesterol after 4 months (P < 0.05). Conclusion: These findings suggest that Hatha yoga exercise has preventive and beneficial effects and may be a safe therapeutic modality in ESRD patients. [ABSTRACT FROM AUTHOR]

Evidence-based recommendations regarding which exercise tests to use in children and adolescents with cerebral palsy (CP) are lacking. This makes it very difficult for therapists and researchers to choose the appropriate exercise-related outcome measures for this group. This study aimed to identify a core set of exercise tests for children and adolescents with CP. Fifteen experts (10 physical therapists/researchers and five exercise physiologists; three from the Netherlands, two from the USA, one from the UK, five from Canada, and four from Australia) participated in a Delphi survey which took four stages to achieve a consensus. Based on the information that was collected during the survey, a core set of measures was identified for levels I to IV of the Gross Motor Function Classification System (GMFCS). For children with CP classified at GMFCS levels I and II, tests were identified for two motor skills (walking and cycling). For the subgroup of children with CP classified at GMFCS level III, the tests that were identified related to walking, cycling, and arm cranking. For children with CP classified at GMFCS level IV, the tests included in the core set were related to cycling and arm cranking. The core set will help physical therapists, exercise physiologists, and other health professionals who work with children and adolescents with CP to decide which test(s) to use in clinical practice or research. This will facilitate comparability of results across studies and clinical programmes. [ABSTRACT FROM AUTHOR]

A novel approach for the patterning and manufacturing of sub-40-nm gate structures is presented. Rather than using resist or an inorganic hardmask as the patterning layer, this gate patterning scheme uses an amorphous carbon (a:C) and cap hardmask to pattern small gates. Healthy and manufacturable gate lengths have been achieved below 35 urn with this scheme, and the potential exists for further extendibility. [ABSTRACT FROM AUTHOR]