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Little is known about spiritual care in small hospitals and critical access hospitals (CAHs), essential sources of health care in rural areas of the US. Using interview-administered surveys with spiritual care providers, we examined spiritual care services in 19 facilities, including seven small hospitals, nine CAHs, and three freestanding emergency departments, in one religiously-owned healthcare system. We identified four groups of facilities based on intensity/frequency of chaplain availability. A central finding was the variation in spiritual care services provided in these diverse facilities. Of the 16 hospitals in the sample, 11 of them (69%) offered spiritual care from professional chaplains at least three days per week. Support for staff was an important priority in all the facilities. Needs identified include virtual training and support for the spiritual care providers in these settings. Future research should replicate this study in a representative sample of hospitals that serve the rural US population.

Background. The COVID-19 pandemic disrupted hospital operations worldwide, including services delivered by occupational therapists (OTs). Purpose. This study aimed to understand the experiences of OTs at one Canadian, tertiary care hospital during the 2021-2022 period of the pandemic. Method. We used a qualitative descriptive approach to describe the experiences of OTs during the pandemic. Findings. While there were similarities in the 10 participating OTs' experiences, salient differences were largely linked to the method of service delivery. Inpatient OTs benefitted from the support of colleagues and developed coping strategies in response to high levels of workplace stress and anxiety and a perceived lack of support from many levels of society. Clinically, they spent more time on discharge planning with fewer resources. OTs providing virtual/hybrid services experienced unique challenges related to adapting their practice to a virtual platform, including challenges assessing patients. They described benefits associated with virtual/hybrid service delivery and brought up concerns around equity of service provision. Conclusion. OTs in this hospital setting faced challenges in providing patient care and supporting their own wellness during the pandemic. Future research could explore the role of leadership in supporting occupational therapy practice during public health emergencies.

To propagate within a eukaryotic cell, pathogenic bacteria hijack and remodulate host cell functions. The Gram-negative obligate intracellular Chlamydiaceae, which pose a serious threat to human and animal health, attach to host cells and inject effector proteins that reprogram host cell machineries. Members of the conserved chlamydial TarP family have been characterized as major early effectors that bind to and remodel the host actin cytoskeleton. We now describe a new function for the Chlamydia pneumoniae TarP member CPn0572, namely the ability to bind and alter the microtubule cytoskeleton. Thus, CPn0572 is unique in being the only prokaryotic protein that directly modulates both dynamic cytoskeletons of a eukaryotic cell. Ectopically expressed GFP-CPn0572 associates in a dose-independent manner with either cytoskeleton singly or simultaneously. In vitro, CPn0572 binds directly to microtubules. Expression of a microtubule-only CPn0572 variant resulted in the formation of an aberrantly thick, stabilized microtubule network. Intriguingly, during infection, secreted CPn0572 also colocalized with altered microtubules, suggesting that this protein also affects microtubule dynamics during infection. Our analysis points to a crosstalk between actin and microtubule cytoskeletons via chlamydial CPn0572., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2024. Published by The Company of Biologists Ltd.)

Objective: To document the impact of stroke on employment income among people employed at the time of stroke., Design: Population-based cohort study., Participants: People hospitalized for stroke in Ontario, Canada (2010-2014) and people without stroke matched on demographic characteristics., Main Measures: Robust Poisson regression to estimate the effects of stroke on the probability of reporting employment income on tax returns over 3 years. Quantile regression difference-in-differences to estimate the changes in annual employment income attributable to stroke., Results: Stroke survivors were increasingly less likely to report any employment income poststroke, incidence rate ratios (IRR) 0.87 at 1 year (95% confidence intervals [CI]; 0.85-0.88), 0.82 at 2 years (95% CI; 0.81-0.84) and 0.81 at 3 years (95% CI; 0.79-0.82). IRR for reporting at least 50% of prestroke income levels were 0.76 at 1 year (95% CI; 0.75-0.78), 0.75 at 2 years (95% CI; 0.73-0.77) and 0.73 at 3 years (95% CI; 0.71-0.75). IRR for reporting at least 90% of prestroke income levels were 0.72 at 1 year (95% CI; 0.70-0.74), 0.66 at 2 years (95% CI; 0.64-0.68) and again 0.66 at 3 years (95% CI; 0.64-0.68). Relative changes in annual employment income attributable to stroke varied from a decrease of 13.8% (95% CI; 8.7-18.9) at the 75th income percentile to a decrease of 43.1% (95% CI; 18.7-67.6) at the 25th income percentile., Conclusions: It is important for healthcare and service providers to recognize the impact of stroke on return to prestroke levels of employment income. Low-income stroke survivors experience a more drastic loss in employment income and may need additional social support., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Access to the datasets for this study was approved through the Statistics Canada Microdata Access Portal. The data were accessed at a university-based Research Data Centre. Although the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada.

Purpose: Following stroke, individuals who live in a low-income or are at risk of living in a low-income situation face challenges with timely access to social services and community resources. Understanding the usual care practices of stroke teams, specifically, how they support this access to services and resources, is an important first step in promoting the implementation of practice change., Method: A qualitative multiple-case study of acute care, inpatient, and outpatient rehabilitation stroke teams in an urban area of Canada. Semi-structured interviews and questionnaires about the workplace context were conducted with 19 professionals (social workers, occupational therapists, physiotherapists, speech-language pathologists) at four sites., Results: In their usual practice, stroke teams prioritized immediate care needs. The stroke team professionals did not address income or resources unless it directly affected discharge. Usual care was influenced by factors such as time constraints, lack of knowledge about services and resources, and social service system limitations., Conclusion: To better support post-stroke access to social services and resource for low-income individuals, a multidisciplinary approach, with actions beginning earlier on and extending throughout the continuum of care, is recommended, in addition to system-level advocacy.

Objective: We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and family well-being., Design: We conducted a 12-month prospective cohort study in Zimbabwe with 123 primary caregivers of children ages 9 to 15 years who were HIV positive but did not know their serostatus at baseline. By the end of the study period 65 caregivers reported that their child learned his or her HIV-positive status., Main Outcome Measures: We used three waves of data to compare caregivers' pre-disclosure worries to post-disclosure reports and to characterise associations between disclosure and well-being of the child (Strengths and Difficulties Questionnaire), caregiver (Patient Health Questionnaire-9), and family (Family Relationship Quality) over time., Results: Caregivers' pre-disclosure worries and fears about how their child would react to disclosure of their HIV status largely went unrealised. Furthermore, we did not find strong evidence of clinically-important increases in problems on average following disclosure., Conclusion: Findings support the call to identify supportive intervention strategies that address caregiver fears at the beginning of the disclosure process.

Given that autistic children are hospitalized at higher rates than neurotypical peers, it is important to understand the autism-specific preparedness of healthcare providers. Certified Child Life Specialists (CCLSs) play a crucial role in pediatric hospitalizations by providing socioemotional support and coping strategies. The present study assessed perceived competency and comfort levels among 131 CCLSs regarding the management of challenging behaviors exhibited by autistic pediatric patients, including aggression and self-injury. All participants reported experiences providing care to autistic children who exhibited challenging behaviors, but very few reported both high perceived competency and high comfort in managing these behaviors. Autism-specific training positively correlated with perceived competency and comfort. These results have implications for providing autistic children high quality hospital care., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Finding and accessing social services and community resources are a challenge for stroke survivors and care partners. The purpose of this systematic review was to identify and review interventions that aimed to increase access and use of such services and resources post stroke., Method: A systematic review of the published literature was performed using MEDLINE, CINAHL, PsycINFO, and ProQuest Nursing and Allied Health (January 2008 to May 2020). Studies were included if they were quantitative designs and reported on outcomes of interventions addressing post-stroke access to social services or community resources. Results were synthesised narratively., Results: 3566 titles and abstracts were reviewed. Ten articles met the inclusion criteria. The interventions included in this review varied in terms of target group, timing, and type of support provided (passive or active tailored information provision, referral service, navigation assistance). Outcome measures, for social service and community resource access, included discharge preparedness measures, service counts, observations, satisfaction evaluations, interviews, and open-ended questions., Conclusion: Overall, interventions demonstrated some improvements in information received and access to social services and community resources following stroke. Future research should focus on carrying out high quality studies that examine the effectiveness of various social service and community resource interventions, and on setting valid and reliable outcome measures.IMPLICATIONS FOR REHABILITATIONStroke survivors and care partners have unmet social service and community resource needs.Stroke survivors and care partners can benefit from interventions that provide information, referrals, and ongoing support to access services and resources.Clearly identifying social service and community resource needs is important for tailoring interventions to individual situations.Interventions should ideally be provided throughout the hospital stay, in acute care and rehabilitation, and continue on in the community.

Background: Seriously ill patients admitted to the Intensive Care Unit (ICU) experience severe spiritual and existential distress. Patients' surrogate decision makers face the burden of making complex decisions about their loved ones' care. Experienced chaplains may play a role in assisting with decision-making, possibly by aligning patients' values and wishes with treatment plans and avoiding non-beneficial aggressive measures., Objectives: To identify associations between chaplaincy care and length of stay (LOS) in the medical ICU (MICU)., Methods: This was a retrospective observational study of usual spiritual care in the adult MICUs of 4 medical centers in the United States over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information. Through bivariate and multivariable analyses associations between spiritual care and LOS were examined., Results: In multivariable analysis of the 254 patients, receiving spiritual care was associated with an increased likelihood of being in a higher LOS tertile (adjusted odds ratio = 2.94, p < .001). In post hoc bivariate analysis, cases receiving spiritual care within the first 48 hours of MICU admission revealed a trend toward lower LOS (p = .181)., Conclusion: Spiritual care in the MICU was associated with longer LOS. Early intervention by chaplains who are well-integrated in the ICU may assist patients and their loved ones in coming to terms with grave illness and making difficult treatment decisions. Further well-designed studies of spiritual care interventions that may affect outcomes are needed.

Overdrinking and non-osmotic arginine vasopressin release are the main risk factors for exercise-associated hyponatremia (EAH) in ultra-marathon events. However, particularly during ultra-marathon running in mountainous regions, eccentric exercise and hypoxia, which have been shown to modulate inflammation, hormones regulating fluid homeostasis (hypoxia), and oxidative stress, could contribute to serum sodium changes in a dose-dependent manner. To the best of our knowledge, the contribution of these factors, the extent of which depends on the duration and geographical location of the race, has not been well studied. Twelve male participants (11 finishers) of the short (69km, 4,260m elevation-gain) and 15 male participants (seven finishers) of the long (121km, 7,554m elevation-gain) single-stage Südtirol Ultra Sky-Race took part in this observational field study. Venous blood was drawn immediately before and after the race. Analyses included serum sodium concentration, copeptin (a stable marker for vasopressin), markers of inflammation, muscle damage and oxidative stress. Heart rate was measured during the race and race time was obtained from the race office. During the short and the long competition two and one finishers, respectively showed serum sodium concentrations >145mmol/L. During the long competition, one athlete showed serum sodium concentrations <135mmol/L. Only during the short competition percent changes in serum sodium concentrations of the finishers were related to percent changes in body mass ( r =-0.812, p =0.002), total time ( r =-0.608, p =0.047) and training impulse (TRIMP) ( r =-0.653, p =0.030). Data show a curvilinear (quadratic) relationship between percent changes in serum sodium concentration and body mass with race time when including all runners (short, long, finishers and non-finishers). The observed prevalence of hypo- and hypernatremia is comparable to literature reports, as is the relationship between serum sodium changes and race time, race intensity and body mass changes of the finishers of the short race. The curvilinear relationship indicates that there might be a turning point of changes in serum sodium and body mass changes after a race time of approximately 20h. Since the turning point is represented mainly by non-finishers, regardless of race duration slight decrease in body mass and a slight increase in serum sodium concentration should be targeted to complete the race. Drinking to the dictate of thirst seems an adequate approach to achieve this goal., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Schenk, Rauch, Procter, Grasegger, Mrakic-Sposta and Gatterer.)

The use of crystal engineering to control the supramolecular arrangement of π-conjugated molecules in the solid-state is of considerable interest for the development of novel organic electronic materials. In this study, we investigated the effect of combining of two types of supramolecular interaction with different geometric requirements, amide hydrogen bonding and π-interactions, on the π-overlap between calamitic π-conjugated cores. To this end, we prepared two series of bithiophene diesters and diamides with methylene, ethylene, or propylene spacers between the bithiophene core and the functional groups in their terminal substituents. The hydrogen-bonded bithiophene diamides showed significantly denser packing of the bithiophene cores than the diesters and other known α,ω-disubstituted bithiophenes. The bithiophene packing density reach a maximum in the bithiophene diamide with an ethylene spacer, which had the smallest longitudinal bithiophene displacement and infinite 1D arrays of electronically conjugated, parallel, and almost linear N-H⋅⋅⋅O=C hydrogen bonds. The synergistic hydrogen bonding and π-interactions were attributed to the favorable conformation mechanics of the ethylene spacer and resulted in H-type spectroscopic aggregates in solid-state absorption spectroscopy. These results demonstrate that the optoelectronic properties of π-conjugated materials in the solid-state may be tailored systematically by side-chain engineering, and hence that this approach has significant potential for the design of organic and polymer semiconductors., (© 2020 Wiley-VCH GmbH.)

Background: A sufficient supply of oxygen is crucial to avoid hypoxic cardiac arrest and brain damage within 30 min in completely-buried avalanche victims. Snow density influences levels of hypoxia and hypercapnia. The goal of this study was to investigate the effects of hypoxia and hypercapnia on cerebral oxygenation (ScO 2 ) in humans breathing into an artificial air pocket., Methods: Each subject breathed into a closed system (air-tight face mask - plastic tube - snow air-pocket of 4 L) up to 30 min. Each subject performed three tests in different snow densities. ScO 2 was measured by a near-infrared spectroscopy (NIRS) device. Measurements included peripheral oxygen saturation (SpO 2 ), end-tidal carbon dioxide (ETCO 2 ), air pocket gases and blood gases. Snow density was assessed via standard methods and micro-computed tomography. Based on predetermined criteria, tests were classified based on whether they were terminated before 30 min and the reason for termination. The categories were: completed tests (30 min), tests terminated before 30 min when SpO 2 dropped to ≤75% and tests that were terminated before 30 min by requests of the subjects. General linear models were used to compare termination groups for changes in ScO 2 , ETCO 2 , SpO 2 and air pocket gases, and a multivariate analysis was used to detect factor independent effects on ScO 2 ., Results: ScO 2 was decreased in the group in which the tests were terminated for SpO 2  ≤ 75% caused by a decrease in oxygen supply in high snow densities. In the completed tests, an increase in ScO 2 occurred despite decreased oxygen supply and decreased carbon dioxide removal., Conclusions: Our data show that ScO 2 determined by NIRS was not always impaired in humans breathing into an artificial air pocket despite decreased oxygen supply and decreased carbon dioxide removal. This may indicate that in medium to low snow densities brain oxygenation can be sufficient, which may reflect the initial stage of the triple H (hypothermia, hypoxia, and hypercapnia) syndrome. In high snow densities, ScO 2 showed a significant decrease caused by a critical decrease in oxygen supply. This could lead to a higher risk of hypoxic cardiac arrest and brain damage., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Gravely ill patients admitted to the intensive care unit (ICU), and their families experience acute spiritual and existential needs and often require complex decisions about their care. Little is known about what constitutes chaplaincy care for patients or families in ICUs. Chaplains report that participation in medical decision-making is part of their role., Objective: To describe the spiritual care provided to patients and their families in the ICU., Methods: This was a retrospective observational study of spiritual care for patients and families in the medical ICUs (MICUs) at 4 medical centers over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information (number of visits, length of visit, chaplain categories, and type of spiritual care provided)., Results: Of the 254 patients, 197 (78%) received a total of 485 spiritual care visits. Seventy-seven percent of visits included provision of emotional/spiritual support; only 15% included decision-making support such as family meetings or goals-of-care conversations. The proportion receiving spiritual care increased as patients neared death or discharge. Staff chaplains were involved in goals-of-care conversations to a greater extent than student or part-time chaplains ( P < .05)., Conclusion: Spiritual care was provided to most patients and/or families at the end of life. Low chaplain involvement in decision-making in the MICU suggests opportunities to improve chaplains' contributions to ICU care.

Background: Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered., Objectives: We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN., Methods: We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14 days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models., Results: Premature birth (b = -0.721), caffeine (b = -0.302), and the behavioural states quiet and awake (b = -0.283), active and asleep (b = -0.158), and quiet and asleep (b = -0.498) were associated with changes in behavioural pain scores. Premature birth (b = -0.232), mechanical ventilation (b = -0.196), and duration of the heel stick procedure (b = 0.0004) were associated with changes in physiological pain scores. Premature birth (b = -0.907), Caffeine (b = -0.402), the behavioural states quiet and awake (b = -0.274), and quiet and asleep (b = -0.459), and duration of the heel stick procedure (b = 0.001) were associated with changes in the modified BPSN total scores., Conclusions: Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates' pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs., Significance: We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population., (© 2020 European Pain Federation - EFIC®.)

Background:  Standard performance parameters measured during a laboratory test have been shown to be related to mountain ultra-marathon performance up to a competition length of 75 km. It is not known if a similar relationship exists for longer races., Objective:  This study aimed to investigate the association between laboratory-based performance parameters and performance times in a short (68 km) and a long (121 km) mountain ultra-marathon., Materials and Methods:  Eleven male finishers of the short race and seven male finishers of the long race were investigated. Participants performed an incremental exercise test to exhaustion in the 2 weeks prior to the event. During the event, the heart rate was monitored and finishing times were registered., Results:  The maximal oxygen consumption and the oxygen uptake at the ventilatory thresholds 1 and 2 were related to performance time during the short run (~12h; r = -0.764 up to r = -0.782; p < 0.05), but there was no correlation during the long race (~28h; r = -0.107 to 0.357; p > 0.05)., Conclusions:  This study shows that physical fitness parameters established in a laboratory setting determine competition completion times in ultra-mountain marathon events lasting for ~12 h. During longer races, i. e. ~28 h, other factors not established in the present investigation, such as experience, race strategy, coping with pain and fatigue resistance, may be important for performance., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Suspension syndrome describes a potentially life-threatening event during passive suspension on a rope. The pathophysiological mechanism is not fully understood; however, the most widespread hypothesis assumes blood pools in the lower extremities, prompting a reduction in cardiac preload and cardiac output and leading to tissue hypoperfusion, loss of consciousness, and death. The aim of this study was to assess venous pooling by ultrasound in simulated suspension syndrome using human subjects., Methods: In this trial, 20 healthy volunteers were suspended in a sit harness for a maximum of 60 min with and without preceding exercise. Venous pooling was assessed by measuring the diameter of the superficial femoral vein (SFV) with ultrasound at baseline in supine and standing positions as well as during and after suspension., Results: SFV diameter increased and blood flow became progressively sluggish. In 30% of the tests, near syncope occurred. However, SFV diameter did not differ between subjects with and without near syncope., Conclusions: Free hanging in a harness leads to rapid venous pooling in the lower limbs. The most important measure to prevent suspension syndrome might be constant movement of the legs., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Mental disorders in the perinatal period (PMD) can severely harm women and their children if not detected early and treated appropriately. Even though mental health care is covered by health insurance and is used widely by women in the perinatal period in Switzerland, it is not known if the care provided is meeting the needs of the patients and is efficient in the view of health care professionals. The aim of this study is to identify strengths, gaps and requirements for adequate mental health care in the perinatal period from the perspectives of patients and care providers for a wide range of relevant mental disorders., Methods: In the qualitative study we conduct (1) semi-structured single interviews with former PMD patients to obtain narratives about their experiences and needs for health care for their condition. Women are included who have been treated for PMD but are mentally stable at the time of the interview (n = 24). We will stratify the sample by 4 clusters of relevant ICD-10 F-diagnoses, covering the most frequent and the most severe mental disorders. We will further stratify the sample based on whether the women already had experience with psychiatric or psychological health care or not before their last episode of PMD. We will also conduct (2) three interprofessional focus groups with health and social care professionals involved in perinatal care, and a health insurance representative. The focus groups will consist of 5-8 professionals. Data collection and thematic analysis will consider Levesque's et al. (2013) conceptual model on access to health care., Discussion: The study will provide fundamental data on the experiences and perspectives about perinatal mental health care from user and provider perspectives. The study will generate the evidence base needed to develop models of integrated, coordinated, patient- and family-centred care that is accessed by women with various types of PMD., Trial Registration: The study was registered on ClinicalTrials.gov in November 2019 under the identifier NCT04185896.

Purpose: The main purpose is to produce a French-Canadian translation of the "STrengthening the Reporting of OBservational studies in Epidemiology" (STROBE) Statement under the proposed name of "outil STROBE" and to assess the cross-cultural validity of its content. The secondary purpose is to examine its preliminary interrater reliability. Method: A modified approach to Vallerand's cross-cultural validation methodology was used. First, professional translators and clinical practitioners produced a parallel reverse translation of the "STROBE Statement." Then, a committee of experts (P1) examined the translated versions and created a first experimental draft of the "outil STROBE." This draft was assessed and modified by a second committee of experts (P2). Finally, 32 future professionals doing their master's degree in physiotherapy and occupational therapy assessed this second experimental version of the tool using an ambiguity scale of 8 points (0 meaning "not at all ambiguous" and 7 meaning "extremely ambiguous"). The main co-researchers examined the problematic elements and proposed final modifications. Ten observational studies published in French after 1980 were assessed by two independent raters using the French-Canadian version of the "outil STROBE." The kappa coefficient was used to examine interrater reliability. Results: For the different elements of the final version of the "outil STROBE," the averages on the ambiguity scale varied from 0.0 to 2.4. No element received an average below 2.4, which showed a high level of clarity. The interrater reliability ( n = 2) for the "outil STROBE" is thought to be good for 74% of individual elements, according to the kappa coefficient values obtained. Conclusions: The process's five rigorous steps enabled the production of a valid French-Canadian version of the "STROBE Statement.", Competing Interests: Conflits d’intérêts : Les auteurs n’ont aucun conflit d’intérêts à déclarer.

Castagna, C, Bizzini, M, Araújo Póvoas, SC, Schenk, K, Büsser, G, and D'Ottavio, S. Aerobic fitness in top-class soccer referees. J Strength Cond Res 33(11): 3098-3104, 2019-The aim of this study was to examine the aerobic fitness status of top-class male soccer officials using a cross-sectional design and known population group constructs. Fifty-two field referees (FRs, age 38.4 ± 3.3 years; height 181 ± 5.6 cm; body mass 76.8 ± 6.8 kg; body mass index [BMI] 23.4 ± 1.7 kg·m; body fat 20.4 ± 3.6%; and international refereeing experience 5 ± 3.5 years) and 104 assistant referees (ARs, age 37.8 ± 4.1 years; height 176.9 ± 7.5 cm; body mass 72.1 ± 7.4 kg; BMI 23 ± 1.6 kg·m; body fat 19.2 ± 3.6%; and international refereeing experience 7 ± 3.8 years) from 53 National Football Associations worldwide, and candidates of the preliminary open-list developed by the FIFA Refereeing Department for the 2014 World Cup Final Tournament, were tested for aerobic fitness in laboratory conditions with a progressive speed treadmill test to exhaustion. Large (+8.54%, d = 0.8) and small (+3.1%, d = 0.3) differences in absolute (L·min) and relative (ml·kg·min) VO2max were found between FR and AR, respectively. Trivial differences (d = 0.07) were shown in running economy (RE) (6 minutes at 8 km·h) between AR and FR. Using the scaling notation (b = 0.64), medium and significant differences were found between match officials for VO2max and RE (FR > AR; d = 0.6 and 0.67, respectively). Using receiver operating characteristic curve statistics, cutoff values of 3.93 L·min and 50.6 ml·kg·min were detected in absolute and relative VO2max for the FR and the AR (FR > AR), respectively. The FR showed superior aerobic fitness compared with AR. Training prescription should consider intensities at anaerobic threshold speed (14 km·h, 91% heart rate max) when aerobic fitness development is the aim in elite officials.

Objectives: Fewer than half of children receive all recommended immunizations on time. Hospitalizations may be opportunities to address delayed immunizations. Our objectives were to assess (1) prevalence of delayed immunizations among hospitalized patients, (2) missed opportunities to administer delayed immunizations, and (3) time to catch up after discharge., Methods: We conducted a retrospective cohort study investigating immunization status of patients 0 to 21 years of age admitted to an academic children's center from 2012 to 2013 at the time of admission, at discharge, and 18 months postdischarge. Immunization catch-up at 18 months postdischarge was defined as having received immunizations due on discharge per Centers for Disease Control and Prevention recommendations. χ 2 and t test analyses compared characteristics among patients caught up and not caught up at 18 months postdischarge. Analysis of variance and logistic regression analyses compared mean number of immunizations needed and odds of immunization catch-up among age groups. Kaplan-Meier and Cox proportional hazards analyses compared catch-up time by age, race, sex, and insurance., Results: Among 166 hospitalized patients, 80 were not up to date on immunizations at admission, and only 1 received catch-up immunizations before discharge. Ninety-nine percent (79 of 80) were not up to date on discharge per Centers for Disease Control and Prevention recommendations. Thirty percent (24 of 79), mostly adolescents, were not caught up at 18 months postdischarge. Median postdischarge catch-up time was 3.5 months (range: 0.03-18.0 months). Patients 0 to 35 months of age were more likely to catch up compared with those of other ages (hazard ratio = 2.73; P = .001), with no differences seen when comparing race, sex, or insurance., Conclusions: Pediatric hospitalizations provide important opportunities to screen and immunize children., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

Background: Client-centred goal setting is central to the process of enabling occupation. Yet, there are multiple barriers to incorporating client-centred goal setting in practice. We sought to determine what might facilitate or impede the formation of client-centred goals in a context highly supportive of client-centred goal setting Methods: We used conversational analysis to examine goal-setting conversations that took place during a pilot trial of Occupational Performance Coaching for stroke survivors. Twelve goal-setting sessions were purposively selected, transcribed, and analyzed according to conventions for conversation analysis., Results: Two main types of interactions were observed: introductory actions and goal selection actions. Introductory actions set the context for goal setting and involved sharing information and seeking clarification related to goal requirements and clients' occupational performance competencies. Goal selection actions were a series of interactions whereby the goals were explored, endorsed or dropped., Conclusion: Client-centred occupational performance goals may be facilitated through placing goal-setting in the context of life changes and lifelong development of goals, and through listening to clients' stories. Therapists may improve consistency in adoption of client-suggested goals through clarifying meaning attached to goals and being attuned to power dynamics and underlying values and beliefs around risk and goal attainability.

Purpose: The main purpose of this article is to produce a French-Canadian translation of the Consolidated criteria for reporting qualitative studies (COREQ) scale under the proposed name "échelle COREQ" and to assess the transcultural validity of its content. The secondary purpose is to examine the inter-rater reliability of the French-Canadian version of the COREQ scale. Method: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used. First, a parallel back-translation of the COREQ scale was performed, by both professionals and clinicians. Next, a first committee of experts(P1) examined the translations to create a first draft of the French-Canadian version of the COREQ scale. This draft was then evaluated and modified by a second committee of experts (P2). Finally, 28future professionals (master's students in physiotherapy) rated this second draft of the tool for clarity using a seven-point scale (1:very clear; 7:very ambiguous). The principal co-investigators then reviewed the problematic elements and proposed final changes. Two independent raters used this French-Canadian version of the COREQ scale to assess 13qualitative studies that were published in French after the year2007. The kappa coefficient was used to examine inter-rate reliability. Results: The different elements of the final version of the COREQ scale received an average ambiguity rating between 1.04 and 2.56. These low values show a high level of clarity for the French-Canadian version of the COREQ scale. In relation to the total score of the COREQ scale, inter-rater reliability ( n  = 2) is considered to be average to excellent for 62.5% of individual elements, according to the kappa values obtained. Conclusions: A valid French-Canadian version of the COREQ scale was created using this rigorous five-step process., (© Canadian Physiotherapy Association.)

Objective: To examine operational definitions of return to work (RTW) poststroke and provide more precise estimates of RTW through meta-analysis., Data Sources: A systematic search was conducted using MEDLINE, CINAHL, PsycINFO, and SCOPUS (2005 to March 26, 2018). The search strategy involved expansion of medical subjective headings using terms related to stroke and work. The reference lists of review articles and included studies were checked for additional relevant studies., Study Selection: Studies were included if they (1) quantitatively analyzed RTW outcomes or factors associated with RTW; (2) reported RTW outcomes for participants employed prior to stroke; and (3) were written in English or French. Two reviewers independently screened titles and abstracts. Of 7265 articles initially identified, 55 studies were included., Data Extraction: Data were extracted and study quality was assessed by 1 reviewer and verified by a second reviewer., Data Synthesis: Explicit and implicit operational definitions of RTW were determined and categorized. Ranges of RTW estimates were presented for study and participant characteristics. Pooled summary estimates were calculated for comparable studies by follow-up time poststroke: 55.7% at 1 year (95% confidence interval [95% CI], 51.3%-60.0%) and 67.4% at 2 years (95% CI, 60.4%-74.4%). Similar summary estimates were noted when only population-based studies were considered: 56.7% at 1 year (95% CI, 48.3%-65.1%) and 66.7% at 2 years (95% CI, 60.2%-73.2%)., Conclusions: Operational definitions varied across studies and were often not explicitly reported. To promote comparability of RTW outcomes in future studies, we recommend working toward a universal operational definition and consistent follow-up times. The more precise estimates calculated in this review could be used as benchmarks for health care and social service providers., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: The objective of this study was to estimate the prevalence of pediatric HIV disclosure in rural Zimbabwe and track the process of disclosure over time., Methods: We recruited a population-based sample of 372 caregivers of HIV-positive children ages 9 to 15 to participate in a survey about disclosure. Using data from this cross-sectional sample, we then identified a prospective cohort of 123 caregivers who said their HIV-positive child did not know his or her HIV status, and we followed this non-disclosed cohort of caregivers through two additional waves of data collection over the next 12 months. At each wave, we inquired about the timing and process of disclosure and psychosocial factors related to HIV disclosure., Results: The overall prevalence of disclosure in the cross-sectional sample was 66.9% (95% CI 62.0 to 71.5%). Only 26.9% of children knew how they were infected and that they can transmit the virus to others (i.e. "full disclosure"). Older children were more likely to know their status. Among the non-disclosed caregivers at baseline, nearly 60% of these children learned their HIV status over the course of the 12-month study period, but only 17.1% learned how they were infected and that they can transmit the virus to others. Most caregivers were satisfied with their child's disclosure experience. Caregivers who had not disclosed their child's HIV status to the child worried that disclosure would lead to stigma in the community, provoke questions from their child they would not be able to answer, or cause the child to reject the caregiver in anger., Conclusions: This study suggests that rates of pediatric HIV disclosure may be larger than typically reported, but also reinforces the idea that most children do not know key details about their illness, such as how they were infected and that they can infect others., Competing Interests: The authors have declared that no competing interests exist.

Background.: Late stroke rehabilitation interventions often target impairment with limited carryover to daily occupation., Purpose.: This study explored whether the LSVT BIG program could lead to improved performance in client-identified occupations and decreased impairment late poststroke., Method.: A single-case experimental design with one repetition was completed. Participants were two adults who had experienced a stroke 3 and 12 years previously. Each participant selected up to six occupational goals, and the intervention was applied to half. Repeated measures were taken using the Canadian Occupational Performance Measure and the Rating of Everyday Arm-Use in the Community and Home. Additional measures of performance and impairment were applied pre- and postintervention., Findings.: Performance improved on either self-assessment or blinded-rater assessment for all but one activity (trained or untrained)., Implications.: LSVT BIG is a promising intervention to improve occupational performance. Further research is required to clarify elements of the program essential to improving occupational performance.

Background: Breast-conserving treatment (BCT) for breast cancer can lead to deformation of the treated breast, resulting in patient dissatisfaction with the final cosmetic outcome. Currently, literature on the specific information needs of patients concerning the cosmetic effects of BCT is lacking. The aim of the present study was to investigate the information needs of breast cancer patients regarding the long-term cosmetic outcome after BCT., Subjects, Materials, and Methods: The data from 115 women who had undergone BCT in a general teaching hospital breast cancer unit in The Netherlands were studied. Structured questionnaires and semi-structured interviews were conducted between October 2012 and April 2013. A mixed model of quantitative and qualitative research was used to explore patient-reported information needs. A phenomenological approach was used to analyze the qualitative data., Results: This study shows that women undergoing BCT want to discuss long-term cosmetic effects. Most patients appreciate such information immediately after the diagnosis. Patients indicated that it is also important to pay attention to the cosmetic effects during the follow-up visits, because deformation of the breast can also occur at a later stage. Furthermore, half the patients indicated that they would not likely raise the subject of cosmetic effects of the treatment themselves., Conclusion: Breast cancer patients have a need for long-term attention for cosmetic outcome of BCT, which should be tailored during the treatment and follow-up process., Implications for Practice: Currently, no literature exists concerning patients' needs for information regarding the cosmetic effects of breast-conserving therapy (BCT). Bringing up the cosmetic effects of BCT by health care professionals does not appear to be a standard part of treatment and follow-up. It is expected that the quality of care and life will be improved by providing information and guidance regarding the cosmetic outcome of BCT within the existing structure of the breast cancer pathway. Discussion and visualization of the cosmetic effects prior to treatment will lead to more realistic expectations, and as a result, secondary interventions, such as partial prostheses and plastic surgery, may be easier to discuss and accept., Competing Interests: Disclosures of potential conflicts of interest may be found at the end of this article., (© AlphaMed Press 2018.)

Background: Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs., Methods: In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1-5 capillary heel sticks in their first 14 days of life. From each heel stick, we produced three video sequences: baseline; heel stick; and, recovery. Five blinded nurses rated neonates' pain responses according to the BPSN. The underlying factor structure of the BPSN, interrater reliability, concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, sensitivity and specificity, and the relationship between behavioural and physiological indicators were explored. We considered GA and gender as individual contextual factors., Results: The factor analyses resulted in a model where the following behaviours best fit the data: crying; facial expression; and, posture. Pain scores for these behavioural items increased on average more than 1 point during the heel stick phases compared to the baseline and recovery phases (p < 0.001). Among physiological items, heart rate was more sensitive to pain than oxygen saturation. Heart rate averaged 0.646 points higher during the heel stick than the recovery phases (p < 0.001). GA increased along with pain scores: for every additional week of gestation, the average increase of behavioural pain score was 0.063 points (SE = 0.01, t = 5.49); average heart rate increased 0.042 points (SE = 0.01, t = 6.15). Sensitivity and specificity analyses indicated that the cut-off should increase with GA. Modified BPSN showed good concurrent validity with the PIPP-R (r = 0.600-0.758, p < 0.001). Correlations between the modified behavioural subscale and the item heart rate were low (r = 0.102-0.379)., Conclusions: The modified BPSN that includes facial expression, crying, posture, and heart rate is a reliable and valid tool for assessing acute pain in full-term and preterm neonates, but our results suggest that adding different cut-off points for different GA-groups will improve the BPSN's clinical usefulness., Trial Registration: The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461 . Registration date: 12 April 2016.

Breathing under snow, e.g. while buried by a snow avalanche, is possible in the presence of an air pocket, but limited in time as hypoxia and hypercapnia rapidly develop. Snow properties influence levels of hypoxia and hypercapnia, but their effects on ventilation and oxygenation in humans are not fully elucidated yet. We report that in healthy subjects breathing into snow with an artificial air pocket, snow density had a direct influence on ventilation, oxygenation and exhaled CO 2 . We found that a rapid decline in O 2 and increase in CO 2 were mainly associated with higher snow densities and led to premature interruption due to critical hypoxia (SpO 2  ≤ 75%). However, subjects in the low snow density group demonstrated a higher frequency of test interruptions than expected, due to clinical symptoms related to a rapid CO 2 accumulation in the air pocket. Snow properties determine the oxygen support by diffusion from the surrounding snow and the clearance of CO 2 by diffusion and absorption. Thus, snow properties are co-responsible for survival during avalanche burial.