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Background: Invasive vagus nerve stimulation (VNS) has the potential to enhance the effects of physiotherapy for upper limb motor recovery after stroke. Noninvasive, transcutaneous auricular branch VNS (taVNS) may have similar benefits, but this has not been evaluated in stroke recovery. We sought to determine the feasibility of taVNS delivered alongside upper limb repetitive task-specific practice after stroke and its effects on a range of outcome measures evaluating limb function.Materials and Methods: Thirteen participants at more than 3 months postischemic stroke with residual upper limb dysfunction were recruited from the community of Sheffield, United Kingdom (October-December 2016). Participants underwent 18 × 1-hour sessions over 6 weeks in which they made 30-50 repetitions of 8-10 arm movements concurrently with taVNS (NEMOS; Cerbomed, Erlangen, Germany, 25 Hz, .1-millisecond pulse width) at maximum tolerated intensity (mA). An electrocardiogram and rehabilitation outcome scores were obtained at each visit. Qualitative interviews determined the acceptability of taVNS to participants.Results: Median time after stroke was 1.16 years, and baseline median/interquartile range upper limb Fugl-Meyer (UFM) score was 63 (54.5-99.5). Participants attended 92% of the planned treatment sessions. Three participants reported side effects, mainly fatigue, but all performed mean of more than 300 arm repetitions per session with no serious adverse events. There was a significant change in the UFM score with a mean increase per participant of 17.1 points (standard deviation 7.8).Conclusion: taVNS is feasible and well-tolerated alongside upper limb repetitive movements in poststroke rehabilitation. The motor improvements observed justify a phase 2 trial in patients with residual arm weakness. [ABSTRACT FROM AUTHOR]

Sustainable sources of funding for investment in Green Infrastructure have become increasingly difficult to identify due to centralised government financing cuts in the UK. Although local government, as traditional normative funders, have adopted innovative approaches to capital and revenue spending there remains a significant gap in how and what resources are supported. Business Improvement Districts (BIDs) are one set of stakeholders that potentially have a role to play in addressing funding deficits. As subscriber funded organisations, they work at a local level to enhance economic prosperity, as well as delivering socio-cultural and ecological enhancement in identified urban areas. This paper examines the experience of BIDs in London to debate the influences and barriers to their investing in Green Infrastructure. It argues that BIDs can act as critical advocates for Green Infrastructure planning where the latter aligns with local economic objectives. Moreover, we identify spatial variations in the extent to which BIDs in London engage with Green Infrastructure in their documentation and practice, illustrating differences in the perceived value of the concept. We conclude that BIDs hold the potential to facilitate investment in Green Infrastructure due to their position as conduits of business, local government, and community objectives. However, to fully embrace this role balance is needed between the setting of environmental objectives and the need to support local business needs, land ownership issues, and capital/revenue financing considerations. [ABSTRACT FROM AUTHOR]

This action research study examined ways to improve the social functioning, and enhance the social inclusion of some students with special educational needs (SEN) in a rural Irish primary school. A baseline of skills was established through assessment. An intervention was delivered on three levels - tertiary (individual), secondary (small groups), and primary (whole-class) and included training in non-verbal communication skills and relationship-building skills. An assessment of the effects of the intervention showed there was a marked improvement in the non-verbal communication skills of the three participants, a lesser improvement in their relationship-building skills and some improvement in their acceptance by their peers [ABSTRACT FROM AUTHOR]

Here we investigate the response of soils and litter to 5 years of experimental additions of ammonium (NH4), nitrate (NO3), and ammonia (NH3) to an ombrotrophic peatland. We test the importance of direct (via soil) and indirect (via litter) effects on phosphatase activity and efflux of CO2. We also determined how species representing different functional types responded to the nitrogen treatments. Our results demonstrate that additions of NO3, NH4 and NH3 all stimulated phosphatase activity but the effects were dependent on species of litter and mechanism (direct or indirect). Deposition of NH3 had no effect on efflux of CO2 from Calluna vulgaris litter, despite it showing signs of stress in the field, whereas both NO3 and NH4 reduced CO2 fluxes. Our results show that the collective impacts on peatlands of the three principal forms of nitrogen in atmospheric deposition are a result of differential effects and mechanisms on individual components. [Copyright &y& Elsevier]

• People with MS (pwMS) describe the efficacy of using hyperbaric oxygen therapy. • We report on a public involvement approach at an MS centre. • Laboratory-based studies based on experiences of pwMS using oxygen therapy. • ICAM expression on brain endothelia is altered by oxygen treatment used by pwMS. Thousands of people with multiple sclerosis (MS) have used self-administered oxygen therapy in the UK. Clinical trials have been performed, with scant evidence that people with MS have been consulted to explore how they benefit from or how to optimize this treatment. The conventional MS disease disability scores used in trials seldom reflect the effects individuals report when using oxygen therapy to treat their symptoms. Three people with MS and the manager of an MS Centre formed a public involvement group and collaborated with clinicians and scientists to inform a lab-based study to investigate the physiological effects of oxygen therapy on microvascular brain endothelial cells. People with MS often use oxygen therapy at a later stage when their symptoms worsen and only after using other treatments. The frequency of oxygen therapy sessions and hyperbaric pressure is individualized and varies for people with MS. Despite direct comparisons of efficacy proving difficult, most individuals are exposed to 100% O 2 at 1.5 atmosphere absolute (ATA; 1140 mmHg absolute) for 60 min. In a laboratory-based study human brain endothelial cells were exposed in vitro to 152 mmHg O 2 for 60 min with and without pressure, as this equates to 20% O 2 achievable via hyperbarics, which was then replicated at atmospheric pressure. A significant reduction in endothelial cells ICAM-1 (CD54) implicated in inflammatory cell margination across the blood brain barrier was observed under oxygen treatment. By collaborating with people living with MS, we were able to design laboratory-based experimental protocols that replicate their treatment regimens to advance our understanding of the physiological effects of hyperbaric oxygen treatment on brain cells and their role in neuroinflammation. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Sexual health and access to services are a pressing need for young people. This article introduces Link Up, a 3-year project in three African and two Asian countries, to enable and scale up access to integrated HIV services and sexual and reproductive health and rights for marginalized young people. The young people we worked with in this project included young men who have sex with men, young sex workers, young people who use drugs, young transgender people, young homeless people, and other vulnerable young people. The research and programmatic activities of Link Up, as illustrated in this Supplement, have highlighted the importance of recognizing and engaging with diversity among young people to improve access to services and outcomes protecting their health and human rights. [ABSTRACT FROM AUTHOR]

Purpose Working with health providers to reduce HIV stigma in the healthcare setting is an important strategy to improve service utilization and quality of care, especially for young people who are sexually active before marriage, are sexual minorities, or who sell sex. A stigma reduction training program for health providers in Bangladesh was evaluated. Methods A cohort of 300 healthcare providers were given a self-administered questionnaire, then attended a 2-day HIV and sexual and reproductive health and rights training (including a 90-minute session on stigma issues). Six months later, the cohort repeated the survey and participated in a 1-day supplemental training on stigma, which included reflection on personal values and negative impacts of stigma. A third survey was administered 6 months later. A cross-sectional survey of clients age 15–24 years was implemented before and after the second stigma training to assess client satisfaction with services. Results Provider agreement that people living with HIV should be ashamed of themselves decreased substantially (35.3%–19.7%–16.3%; p < .001), as did agreement that sexually active young people (50.3%–36.0%–21.7%; p < .001) and men who have sex with men (49.3%–38.0%–24.0%; p < .001) engage in “immoral behavior.” Young clients reported improvement in overall satisfaction with services after the stigma trainings (63.5%–97.6%; p < .001). Conclusions This study indicates that a targeted stigma reduction intervention can rapidly improve provider attitudes and increase service satisfaction among young people. More funding to scale up these interventions is needed. [ABSTRACT FROM AUTHOR]

Sexual and reproductive health and rights have gained prominence in the HIV response. The role of sexual and reproductive health in underpinning a successful approach to HIV prevention, treatment, care, and services has increasingly been recognized. However, the “second R,” referring to sexual and reproductive rights, is often neglected. This leads to policies and programs which both fail to uphold and fulfill these rights and which fail to meet the needs of those most affected by HIV by neglecting to take account of the human right-based barriers and challenges they face. In this commentary, the authors draw on the approach and practical experiences of the Link Up program, and the findings of a global consultation led for and by young people living with and most affected by HIV, to present a five-point framework to improve programming and health outomces by better protecting, respecting, and fulfilling the sexual health and reproductive rights of young people living with and most vulnerable to HIV. [ABSTRACT FROM AUTHOR]