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Cerebral palsy (CP) is one of the most frequent causes of motor disability in children. Although the definition of CP specifies that the brain lesion to the developing fetal or infant brain is not progressive, it is now well known that the secondary consequences to the musculoskeletal system in a growing child are progressive. The natural history of CP is often characterized by a gradual deterioration of mobility over a 5-year period from childhood to the start of the adolescent growth spurt. For this reason, maintaining or improving gait and gross motor function is a common primary goal for children with CP and orthopaedic gait corrective surgery has been considered standard of care to aid in achieving this goal. Three-dimensional gait analysis (3DGA) has been established as a criterion standard measure to inform surgical intervention and evaluate gait outcomes in children with CP requiring orthopaedic surgery for gait correction. Yet, the reality is that use of 3DGA is uncommon in clinical settings due to the cost involved and the equipment and expertise required. In the absence of 3DGA, observational gait assessment via non-instrumented methods is a viable alternative in informing and reassessing surgical intervention. However, evaluations of orthopaedic surgical interventions must go beyond just assessing the changes in body structure and function associated with gait. The introduction of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) encourages a multidimensional perspective of measuring and documenting health outcomes. This framework creates a shift in focus from just measuring gait-related outcomes (“impairment” of body function and structure), to also measuring “activity” (action or task execution), and “participation” (involvement in life situations) outcomes to allow for more meaningful assessment of the child’s function following gait corrective surgery. There is a long-held assumption that functional activity and participation will improve if gait impairments are treated. However, due to limited reporting of activity and participation measures to reflect surgical outcome, the correlation between gait impairment with activity and participation is poorly understood. Changes in gait may not necessarily translate into clinically significant or meaningful changes in activity and participation. Despite the large body of literature evaluating outcomes of gait corrective surgery for children with CP, there is lack of consensus regarding which non-instrumented measures of gait, activity and participation outcome measures are most suitable to be collected pre- and post-surgery. Therefore, the aim of this scoping review is to identify the most frequently reported non-instrumented measures of gait, activity and participation for children with CP undergoing gait corrective surgery. By doing so, we may be able to help direct further work towards developing a core set of outcome measures for use in routine clinical practice.

ObjectiveDetermine the adherence to and effectiveness of an 8-week home exercise programme for children with disabilities delivered using Physitrack, an online exercise prescription tool, compared with traditional paper-based methods.DesignSingle-blinded, parallel-groups, randomised controlled trial (RCT).SettingIntervention took place in participants’ homes in Western Australia.ParticipantsChildren aged 6 to 17 years, with neurodevelopmental disabilities including cerebral palsy (CP), receiving community therapy services.InterventionAll participants completed an individualised home exercise programme, which was delivered to the intervention group using Physitrack and conventional paper-based methods for the control group.Primary outcome measuresAdherence to exercise programme, goal achievement and exercise performance.Secondary outcome measuresEnjoyment, confidence and usability of Physitrack.ResultsFifty-four participants with CP (n=37) or other neurodevelopmental disabilities (n=17) were recruited. Fifty-three were randomised after one early withdrawal. Forty-six completed the 8-week programme, with 24 in the intervention group and 22 in the control group. There was no difference between the two groups for percentage of exercises completed (intervention (n=22): 62.8% (SD 27.7), control (n=22): 55.8% (SD 19.4), between group mean difference −7.0% (95% CI: −21.6 to 7.5, p=0.34)). Both groups showed significant improvement in their self-rated performance of individualised goal activities, however there was no statistically significant difference between groups for goal achievement, quality of exercise performance, enjoyment, confidence or preferred method of delivery. There were no adverse events.ConclusionPhysitrack provides a therapist with a new means of providing an exercise programme with online tools such as exercise videos, but our preliminary findings indicate that it may be no better than a traditional paper-based method for improving exercise adherence or the other outcomes measured. Exercise programmes remain an intervention supported by evidence, but a larger RCT is required to fully evaluate online delivery methods.Trial registration detailsAustralian New Zealand Clinical Trials Registry; ACTRN12616000743460.

Additional file 1. The MASK Study Group.

Percentage TTR (A) and percentage of RR (B) by quarter (maintenance period) over the course of the service evaluation. (DOCX 24Â kb)

Mineral dust aerosol is a key component of the Earth system, affecting the planet's radiative balance, weather and biogeochemistry as well as having a significant impact on human health and economic well-being. Despite its importance, it is currently poorly represented in global climate models. As a consequence, predicting future dust loading and any associated physical processes is hampered by a high level of uncertainty. A significant factor underpinning the poor representation of dust in models arises from a lack of understanding of the processes that govern its emission at the resolution of these models. In this thesis, a new global dataset of dust emission is derived using data from the Moderate Resolution Imaging Spectroradiometer (MODIS) Deep Blue Collection 6 aerosol dataset. Robust thresholding is applied to the dataset in order to distinguish dust at uplift from aged dust and other aerosols. Threshold values are determined through a global statistical analysis of manned observations of dust at uplift. The resulting dataset compares well to other remotely sensed dust uplift datasets. Controls on dust emission are examined by incorporating the new dust emission dataset in a generalised linear model. Candidate predictor variables that have been suggested to play a controlling role in dust emission are regridded to a common monthly 0.5 degree grid for this purpose. For the first time, a global statistical model is used to confirm and quantify a number of expected relationships between vegetation and climate variables and dust uplift frequency. Other quantities often used in the parameterisation of dust emission, such as the presence of pans, are not found to play a key role in suppressing dust emission at the scale of the study. The detection of dust aerosol often relies on its direct radiative effect in the longwave, a characteristic considered unique among aerosols emitted from the land surface. This assumption is interrogated in this thesis through the examination of a longwave signal from a biomass burning plume in Southern Africa. A series of sensitivity studies using a radiative transfer model are performed to establish that a dust component is not required to replicate the signal. The longwave direct radiative efficiency of the pure biomass burning aerosol case tested here is found to have a value of 4.53Wm-2 per unit aerosol optical depth. The longwave direct effect of biomass burning aerosol in the longwave has possible implications for the understanding of the aerosols's impact on climate and suggests further measurements of the optical properties in the longwave are required. Open Access

Trainee questionnaire. (DOCX 309Â kb)

Trainer questionnaire. (DOCX 307Â kb)

a Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands b Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University,Sweden c Spanish Primary Care Respiratory Group (GRAP), Spain. d Department of Public Health and General Practice, Norwegian University of Science and Technology, Norway e School of Population Health & Clinical Practice, University of Adelaide, Australia f University of Alberta, Canada g International Primary Care Respiratory Group (IPCRG), United Kingdom h Peninsula Medical School, University of Plymouth, United Kingdom i Department of General Practice, University Medical Center Groningen, the Netherlands j Centre of Academic Primary Care, University of Aberdeen, United Kingdom