Search

To systematically summarize the evidence of strategies other than therapy to promote physical activity in hospital settings. Studies testing the various strategies to promote the physical activity of stroke survivors in different hospital settings, including stroke units, hospitals and rehabilitation centres were included. Two independent reviewers screened, extracted data, and assessed the study quality. Quality assessments were performed using standardized checklists. Data synthesis was done from the selected articles and results were reported. Of the 3396 records retrieved from database searches, 12 studies (n = 529 participants) were included. All the studies were of moderate to good quality. The strategies were grouped into five categories: i) physical environment, ii) device-based feedback, iii) self-management approaches, iv) family presence, and v) education. Physical environmental and device-based feedback were the most common strategies to promote physical activity after a stroke in a hospital setting. Strategies such as family presence and education improved physical activity levels, whereas device-based feedback showed mixed results. Despite the importance of physical activity in early stroke, there is limited literature present to enhance activity levels. Physical environment and device-based feedback were the two most common strategies used in acute stroke survivors. The impact of these strategies remain suboptimal to be considered as effective intervention methods to enhance physical activity. • Physical activity of stroke survivors in hospital settings is low. • Environmental modifications and device-based feedback are the common strategies used in stroke survivors to enhance activity. • Education, used as an adjunct to other intervention may benefit to increase activity time. • Measurement of physical activity was either using accelerometer-based outcomes or activities recorded through observations. [ABSTRACT FROM AUTHOR]

Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports. Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports. At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation. Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke. • Adults with stroke demand modification of existing sports for the active participation. • Adaptive sports are, safe, feasible, and well accepted by adults with stroke. • Adaptive sports have the potential to improve physical activity levels in stroke. • Health benefits, fitness, and fun were reported as facilitators for participation. [ABSTRACT FROM AUTHOR]

Abstract Objectives (1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity. Data Sources PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017. Study Selection Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments. Data Extraction Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria. Data Synthesis Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95% confidence interval [95% CI], −0.98 to −0.31; P =.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95% CI, −1.51 to −0.15; P =.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity. Conclusion There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151). [ABSTRACT FROM AUTHOR]

The study examined the effectiveness of Berlinia grandiflora (BEG) and cashew (CEG) exudate gums in protecting mild steel from corrosion in 1 M HCl solution using weight loss, electrochemical impedance spectroscopy (EIS), linear polarization resistance (LPR), and potentiodynamic polarization (PDP). The corrosion products were analyzed using scanning electron microscopy with energy dispersive spectroscopy (SEM/EDX), atomic force microscopy (AFM), Fourier Transformed Infrared spectroscopy (FTIR), and optical profilometry. Results indicate that the exudate gums are effective against the corrosion of mild steel in an HCl solution. The EIS results reveal that the charge transfer resistance of the metal in the acid solution increased from 82.2 Ω cm2 to 1074.0 Ω cm2 and 325.1 Ω cm2 in the presence of 1000 ppm BEG and CEG, respectively corresponding to inhibition efficiency (η) of 92% and 75% at 25 °C. The Gum's performance depends on immersion time and temperature. It improves with an increase in immersion time up to 48 h but thereafter slightly diminishes. The η of 1000 ppm of BEG and CEG after 48 h of immersion is 76% and 67%, respectively at 30 °C. With a temperature rise, η of BEG appreciates to 80% while that of CEG depreciates to 57% at 60 °C after 24 h of immersion. Both BEG and CEG retard the metal corrosion through an adsorptive mechanism whereby it blocks the active corrosion reaction sites on the surface. The adsorption was confirmed by SEM/EDX, AFM, UV–vis, and FTIR. BEG and CEG are promising and sustainable sources for metal corrosion inhibitor formulations. [Display omitted] • BEG and CEG were assessed as sustainable corrosion inhibitors for mild steel in acid medium. • BEG and CEG are effective in protecting mild steel. Inhibition efficiency increases with concentration. • BEG extract outperformed CEG under all testing conditions. • The exudate gums exhibited features peculiar with mixed-type inhibitors. • The inhibition performance of BEG increased with temperature while CEG decreased. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to examine the efficacy of plinth and Swiss ball-based trunk exercise regimes on balance, mobility, physical function, and community reintegration compared with standard physiotherapy in chronic stroke.Subjects and Methods: This observer-blinded parallel-group randomized trial was conducted in outpatient stroke units. People with chronic stroke aged between 30 and 75 years, first onset of unilateral cortical lesion, poor trunk performance, 10 m independent walking ability with or without walking aids, and absence of pusher syndrome were included. Trunk Impairment Scale 2.0, Brunel Balance Assessment, Tinetti scale, gait speed, Stroke Impact Scale-16, and Reintegration to Normal Living Index were the measures. Experimental interventions involved the practice of selective upper and lower trunk movements using either plinth or Swiss ball. Control group received standard physiotherapy. All the patients practiced 1 hour exercise session, 3 sessions a week over a duration of 6 weeks and followed up after 3 and 12 months.Results: Of 108 patients allocated into 3 groups, baseline characteristics were similar. Postintervention compared with control group, the plinth, and Swiss ball groups showed significant mean changes in the outcome measures: trunk impairment scale 2.0 (3.6;4.1 points), Brunel Balance Assessment (1-level), Tinetti scale (5;5.2 points), gait speed (.06;.08 m/s), Stroke Impact Scale-16 (8.7;7.2 points), and community reintegration (7.6;8.8 points). These improvements were retained during 3-12 months' follow-up. Statistical significant was set at P < .05.Conclusion: Plinth and Swiss ball-based trunk exercise regimes showed significant improvements in balance, mobility, physical function, and community reintegration in chronic stroke as against standard physiotherapy. [ABSTRACT FROM AUTHOR]

• Clinical model consists of measures relating to cognition, severity and SAFE score. • Kinematic model includes reaction time, total movement time and total displacement. • Combined model includes the SAFE score (clinical) and shoulder flexion (kinematic). • Combined model displays the best predictive function out of the three models. Predicting post-stroke recovery through prediction models is crucial for choosing appropriate treatment options. However, the existing models predominantly incorporate clinical measures although measurement of movement quality using kinematic measures is essential for distinguishing various types of recovery. Thus, this study aimed at determining if, by considering varied aspects of recovery, adding kinematic measurements over clinical measures would better predict upper extremity (UE) motor impairments at three months post-stroke. Eighty-nine stroke survivors (58.9 ± 11.8 years) were assessed for clinical predictors between 4 and 7 days, kinematic predictors within 1 month, and the impairment outcome of the Fugl Meyer Assessment of the UE (FM-UE) at three months post-stroke. Significant predictors (p<0.05) with a variation inflation factor (VIF) <10 were selected for model development. After performing further step-wise selection, three models incorporating clinical outcomes, kinematic measurements, and a combination of these two, respectively, were formulated. The clinical model (R2 = 0.70) included shoulder abduction finger extension (SAFE) scores, the National Institutes of Health Stroke Scale (NIHSS), and the Montreal Cognitive Assessment (MoCA). The kinematic model (R2 = 0.34) included total displacement, total time, and reaction time. The combined model (R2 = 0.72) comprised of SAFE score and shoulder flexion. All the models had a minimal mean squared error on cross validation, which indicated a good validity. The performance of clinical and combined prediction models for predicting three-month post-stroke UE motor recovery was nearly similar. However, in order to detect minimal changes over time and to understand all aspects of motor recovery, there is a need to add instrument-based kinematic measures. [ABSTRACT FROM AUTHOR]

• Bilateral arm training enhances stroke recovery at the motor impairment level (FMA-UE). • The benefits of task-based bilateral arm training are unclear in activity performance and participation in real-life. • The detailed description about task-based BAT such as which hand to use for stabilisation, which hand to use for manipulation, what kind of in-hand manipulation skills to use, and information about task complexity and feedback was unclear Upper limb recovery is a crucial component of stroke rehabilitation aimed to maximize functional activities and reduce disability. Using both arms post stroke is essential to carry out many functional activities but the evidence on bilateral arm training (BAT) is understudied. To investigate the evidence for efficacy of task-based BAT on upper limb recovery, function, and participation post stroke. We included 13 randomized controlled trials, and methodological quality was assessed using Cochrane risk of bias tool and the PEDro scale. The outcome measures such as Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), Box and Block Test (BBT), Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Stroke Impact Scale (SIS) were synthesized and analysed based on ICF. When comparing BAT with control group, BAT showed improvement in the pooled standard mean difference (SMD) of FMA-UE (SMD= 0.62, 95% confidence interval (CI), 0.12 to 1.12, p = 0.01; I2=83%). The control group showed significant improvement in MAL-QOM (SMD= -0.10, 95%CI, -0.77 to 0.58, p = 0.78; I2=89%). Compared to conventional group, BAT showed a significant improvement in BBT (SMD= 0.52, 95%CI, 0.04 to 1.00, p = 0.03; I2=0%). When compared with BAT, unimanual training yielded a significant improvement (SMD= -0.60, 95%CI, -0.98 to -0.22, p = 0.002; I2=0%) in MAL-QOM. In real-life participation, the control group showed improvement in SIS (SMD= -0.17, 95% (CI), -0.70 to 0.37, p = 0.54; I2=48%) over BAT. Task-based BAT appears to improve upper limb motor function post stroke. The benefits of task-based BAT on activity performance and participation in real life are not statistically significant. [ABSTRACT FROM AUTHOR]

The devastating effect of corrosion on the structural integrity of metals surfaces has been of great concern for some time. However, the challenge is to develop a benign and cost effective inhibitor that is highly effective. Addition of substances that exert synergistic influence and blending of different metals inhibitors had been employed. This review article delineates the effect of addition of metals cations and blending on the inhibition efficiency of metals corrosion inhibitors. The mechanisms proposed for the synergistic inhibition resulting from either addition of metals cations or blending are also discuss based on reported experimental data. [ABSTRACT FROM AUTHOR]

The corrosion inhibition effect of polypropylene glycol (PPG) without and with addition of iodide ions at mild steel/0.5 M H 2 SO 4 solution interface was investigated using chemical, electrochemical, and surface analysis methods at different temperatures. Results obtained showed that PPG inhibited the corrosion of mild steel in the acid environment. Addition of iodide ions to PPG is found to synergistically enhance the corrosion inhibitive ability of PPG with efficiency in the vicinity of 98.4%. Temperature–inhibition efficiency relationship suggest physisorption of PPG onto mild steel surface and chemisorption when PPG was combined with iodide ions. Potentiodynamic polarization results showed that PPG behaved as mixed type inhibitor but under anodic control when combined with iodide ions. The adsorption of PPG and PPG–iodide ions mixtures onto the metal surface followed Temkin adsorption isotherm model. [ABSTRACT FROM AUTHOR]

Abstract: Weight loss and electrochemical (open circuit potential, potentiodynamic polarization, and electrochemical impedance spectroscopy) techniques were used to assess the effectiveness of ethanol and acetone extracts of coconut coir dust as corrosion inhibitor for mild steel in 0.5 M H2SO4 solution at 30–60 °C. It was found that both ethanol and acetone extracts of coconut coir dust retard the dissolution of mild steel in 0.5 M H2SO4 solution, but a pronounced effect was noted with ethanol extract. The inhibition efficiency increased with increase in extract concentration but decreased with rise in temperature, which is suggestive of physical adsorption mechanism. Addition of KI was found to synergistically enhance the protective ability of coconut coir dust extracts obtained from both solvent systems investigated. The synergistic effect was confirmed from the synergism parameter (S 0) which was found to be greater than unity. Potentiodynamic polarization result suggests that coconut coir extracts functioned as mixed-type inhibitor. The adsorption of coconut coir dust extracts onto the mild steel surface followed Freundlich adsorption isotherm model. The mechanism of physisorption of the extracts onto the steel surface is proposed from the trend of inhibition efficiency with temperature which is corroborated by the values of activation parameters obtained from the experimental data. [ABSTRACT FROM AUTHOR]

Protecting heat exchanger alloys from corrosion during acid cleaning is sacrosanct and necessitates the development and application of highly–efficient environmentally–friendly corrosion inhibitors. In the present work, gravimetry, electrochemical impedance spectroscopy (EIS), cyclic potentiodynamic polarization (CPDP), cyclic voltammetry and scanning electron microscopy-energy dispersive x-ray spectrophotometry (SEM-EDX) have been employed to investigate the potential of 1–benzylimidazole and its mixture with potassium iodide (KI) for the mitigation of stainless steel (SS316L) corrosion in 1 M HCl solution at 60 °C. After short immersion time, 1–benzylimidazole is found to decrease the weight loss and corrosion rate of the substrate and impacts an inhibition efficiency of ≈ 65% at 2000 ppm dosage. The inhibitor adsorption followed the Freundlich isotherm. The synergism significantly lowers the rate of anodic half–reactions involving Fe and Cr oxidation which, in turn, boosts the inhibitor efficiency to > 80% through a competitive synergism. SEM-EDX characterization confirm that the passive layer formed in the presence of 1–benzylimidazole + KI significantly mitigated against the propagation of localized pitting corrosion. Prolonged immersion time, up to 72 h, lowers the inhibition efficiency of 1–benzylimidazole + KI mixture to 74 %. [ABSTRACT FROM AUTHOR]

Objectives: Our goal was to evaluate a new software capability that integrates registration, segmentation and tumor measurement across serial exams within a picture archiving communication system (PACS) to expedite tumor measurement. Materials and Methods: Patients treated under institutional review board–approved protocols for metastatic melanoma were retrospectively reviewed. Of the 19 included patients, five were male, the median age was 43.2, and all received treatment using an adoptive cell therapy. Seventy-one lung, liver, and subcutaneous tumors were manually measured using RECIST (Response Evaluation Criteria In Solid Tumors) criteria before therapy (baseline computed tomography [CT]) and within 3 months after therapy (follow-up CT). We performed semiautomated registration, segmentation, and RECIST measurements at both time points within PACS (Carestream Health, Rochester, NY). We compared manual and software-generated RECIST measurements using Bland-Altman plots. Results: The median manually measured RECIST diameter for all baseline tumors was 2.1 (1.0–6.2) cm. The refined registration function identified 70/71 (98.6%) tumors on the follow-up CT. On the baseline CT, all 21 liver, 27/32 (84%) lung, and 10/18 (55%) subcutaneous tumors completed segmentation. On the follow-up CT, 19/21 (90%) liver, 21/27 (78%) lung, and 8/10 (80%) subcutaneous tumors completed segmentation. The Bland-Altman plot demonstrated a 95% confidence interval of ±0.7 cm when comparing the software-generated and manual RECIST measurements. Conclusions: The PACS software performed semiautomated baseline tumor measurements and fully automated follow-up tumor measurements in a majority of lung, liver, and subcutaneous tumors. In our patients, semiautomated metastatic tumor measurement did not obviate the need for physician oversight due to disease and treatment-related factors. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Screening for sexually transmitted infections (STIs) is a crucial element of improving health and reducing disparities, and young men who have sex with men (YMSM) face high rates of both STIs and human immunodeficiency virus. We examined sexual health screening among a diverse sample of adolescent YMSM living in New York City. Methods: Between 2009 and 2011, cross-sectional data were collected from 590 YMSM in New York City. Separate multivariable logistic regression models were used to assess the relationship between sociodemographic, psychosocial, and health and healthcare related factors and two main outcomes: having sought a recent sexual health screening (past 6 months) and having a rectal sexual health screening (lifetime). Results: Overall, 46% reported a sexual health screening in the prior 6 months, but only 16% reported ever having a rectal screening for STIs. Rates were higher among ethnic minority YMSM and men who accessed care at clinics. Multivariable results indicated that gay community affiliation, recent unprotected anal sex, and number of lifetime male partners were also associated with seeking a recent screening. Conclusions: Though half of the sample reported recent general screening, rates of lifetime rectal screening are low. Efforts to increase screening may focus on improving provider knowledge and guideline adherence, and educating and encouraging YMSM to access sexual health check-ups. [Copyright &y& Elsevier]

Abstract: Along with ethical considerations, compelling an individual to donate organs, tissues, or bodily fluids brings several legal doctrines into conflict. The privacy of one''s body is generally considered sacrosanct by American courts, which have upheld a competent adult''s right to refuse medical procedures, even in cases when they are necessary to save the life of another. Although medical and legal communities stress “respect for the individual” as being paramount under American jurisprudential principles, the doctrine of “substituted judgment” permits a court to act (for example, by consenting to organ donation) on behalf of an incompetent individual or child. Parents also have the right to cause a child to “donate” an organ, and although a means exists by which the child can refuse, this may not be realistically feasible for young children. The revised Uniform Anatomical Gift Act of 2006, while clarifying issues of who may make organ donation decisions, does not resolve all the practical issues of compelled organ donation for minors. [Copyright &y& Elsevier]

Abstract: To meet its public mandate, the US Food and Drug Administration (FDA) collected studies on the potential health hazards of eating or drinking cloned food products. Based on an earlier National Academy of Sciences study that, on closer analysis, was not nearly as sanguine, the FDA''s report found no evidence of a health risk from the public''s ingestion of cloned food products. This article analyzes the risks the FDA considered, and concludes that there is a disconnect between the risks the FDA assessed in these studies and the risks that might arise from cloned food products. The FDA should consider instituting effective tracking mechanisms and other diagnostics that would permit scientists and the public to answer the question of health risks posed by cloned food products. [Copyright &y& Elsevier]

Abstract: In the area of genometry—the nascent field of science and technology that proposes to apply enhanced understanding of the human genetic code to reshaping our individual and collective destinies—research and development directed toward improving the function of the human brain has not advanced at the same rate as studies focused on physical enhancement. This article describes developments in the area of cognitive enhancement, including the rise in nonmedical uses of prescription drugs. As those without medical ailments continue to take prescription drugs for their cognitive-enhancing side effects, social policy questions about the fairness of such actions will arise. This article also examines the regulation of cognitive enhancers, both by US law and the rules of international competition. [Copyright &y& Elsevier]

Abstract: In the area of genometry—the nascent field of science and technology that proposes to apply enhanced understanding of the human genetic code to reshaping our individual and collective destinies—no topic has generated more interest among the general public, as well as in the athletic community, than the potential for physical enhancement of the human body and its performance. Genometric experiments have produced physically enhanced mice, and the production of similarly enhanced humans may not be far off. Although it is not the objective of most genometric research, the day will come when gene-based “treatments” will enable individuals to build muscle or increase endurance faster than is possible through conventional methods. This article describes developments in the area of physical enhancement that may find application in the “gene doping” of athletes. For example, human performance-related genes may be delivered to athletes using tools developed for research in gene therapy; the protein products of these genes may be administered in recombinant form; and recently discovered small-molecule activators of the major genetic regulatory pathways of physical prowess may be taken orally, providing “exercise in a pill”. This article also describes US and international attempts to regulate and punish the use of prohibited techniques for performance enhancement among athletes. As science advances, defining and detecting “gene doping” becomes increasingly complex. Thus, the study of physical enhancement provides an ideal starting point for the interdisciplinary Redefined Destinies Colloquium''s examination of the intersection between law and science. [Copyright &y& Elsevier]

Abstract: The genomic revolution is bringing with it simultaneous needs for both scientists and nonscientists to understand and assess, in an unvarnished and nonjudgmental way, the implications of genometry. This is the field of science and technology that is taking the genetic code and what we have learned from its secrets, and reshaping our individual and collective human destinies. Together with the editor-in-chief of Gender Medicine, the authors propose an interdisciplinary group—populated by those in science, law, ethics, social policy, and the interested public—to observe, understand, and disseminate information about what is occurring in the fields of biology and chemistry that is the driving force of the genomic revolution. This article discusses the background to the Redefined Destinies Colloquium (RDC) and summarizes 4 of the topics the RDC is studying. [Copyright &y& Elsevier]

Abstract: Compared with women, men die from cancer and coronary artery disease in disproportionately higher numbers and are more susceptible to a host of emotional and developmental disorders. The authors of this article consider what scientific proof or evidence would be required to legally recognize “being male” as a disability, based on the overwhelming number of physical deficiencies to which males are genetically predisposed. The article summarizes major scientific findings on male health problems and explores various laws and policies that might be implicated by treatment of males as a special category recognized by the law. How the law creates categories of individuals and the reasons why these categories are created for legal classification are reviewed. In addition, the potential for a “maleness” defense in the context of criminal law and procedure is assessed. Lastly, the authors examine the policy implications of treating men as a disabled class, and consider how judges, juries, and legislators would view a scientifically based approach to the creation of a class. Given the many false starts in the past, in which the law had embraced what later was shown to be bad science, substantial historical baggage will have to be overcome to convince judges, juries, and legislators that science has now got it in the sense of having established a valid, causal, genetic or biological determinant for behavior. The consideration of a “male deficiency” theory under the law would have to rely on a more inclusive view of legal “disability” and a willingness to allow technologic advances in genetics to inform our understanding of criminal behavior. [Copyright &y& Elsevier]

Abstract: End-of-life decisions are among the most difficult to make or study. When we examined these decisions made under the auspices and protection of stringent state laws, we found no gender bias among patients who chose to end their lives in the face of documented debilitating and terminal diseases. However, in the case of euthanasia as practiced by Jack Kevorkian, we found significant statistical bias against women. Moreover, other data have questioned whether all of Kevorkian''s patients did, in fact, have debilitating and terminal illnesses. In this article, we explore why a gender disparity exists in end-of-life decision making. We conclude that if physician-assisted suicide and euthanasia are to be integrated into any end-of-life medical care policy, stringent legal and medical safeguards will be required. Institution of these safeguards should prevent selection bias in a vulnerable population hastening death for reasons other than medically justifiable conditions or issues of individual autonomy, and should ensure that end-of-life decisions are truly reflective of competent personal choice, free from economic considerations or societal pressure. [Copyright &y& Elsevier]

Abstract: Just as our first article, “Embryonic Stem Cells in Science and Medicine: An Invitation for Dialogue,” in the December 2007 issue of Gender Medicine went to press, two groups of researchers had just announced that adult human somatic cells had been reprogrammed to behave like pluripotent stem cells, and that the reprogrammed cells were able to differentiate into cell types of the 3 germ layers in vitro and in a mouse model. A third group has since done so. Because the reprogrammed cells were not embryonic in origin, the announcements were heralded as “stunning” and “leaps forward,” because, it was argued, the ability to generate stem cells, without destroying embryos in the process, would avoid the difficult ethical questions raised by human embryonic stem (hES) cell research. This article addresses the most recent announcements and briefly retraces the relevant history so that we may consider whether the moral, ethical, and social issues do in fact disappear as a result of these new advancements. We conclude that, despite the hoopla, little has changed. If indeed there were ethical issues surrounding hES cell research, they remain—and remain as urgent to address and resolve as they had been previously. Lastly, we argue that the medical and scientific communities continue to do themselves a disservice by failing to create a cohesive governing body to address and make concrete recommendations concerning the moral, ethical, and related social issues affecting their communities. [Copyright &y& Elsevier]

Abstract: The biotechnology revolution promises unfathomable future scientific discovery. One of the potential benefits is the accelerated introduction of new diagnostics and treatments to the general public. The right medication for the right patient is the goal of personalized medicine, which directly benefits from many of biotechnology''s biggest and most recent advances. The US patent system rewards innovation in medicine and other arts and sciences by granting innovators, for a period of time, the right to exclude others from using what was invented. One of the purposes of the patent system is to trade that right to exclude, and in its stead obtain the patent holder''s obligation to fully and publicly disclose the essence of the innovations so that they can be improved, thus advancing the common welfare. A tension exists between personalized medicine''s need for access to and use of scientific advances and the patent system''s reward of exclusive use or nonuse to innovators. This tension may result in fewer diagnostic and therapeutic tools brought to the market and generally adopted. The risk seems particularly acute with respect to the diagnostic and therapeutic tools arising from genetic testing that hold specific value for a subset of the population. The judicial system has introduced ethical exceptions that overcome a patent holder''s right to exclude; these judicial overrides relate to the provision of certain types of medical procedures and the development of certain types of new drugs, and not, apparently, to the use of diagnostic and therapeutic tools essential to the success of personalized medicine. A serious question exists as to whether legislative action is necessary to increase public access to genetic testing. [Copyright &y& Elsevier]

Abstract: The different legal, social, and medical approaches to ritually based male and female genital circumcision in the United States are highlighted in this article. The religious and historical origins of these practices are briefly examined, as well as the effect of changing policy statements by American medical associations on the number of circumcisions performed. Currently, no state or federal laws single out male circumcision for regulation. The tolerant attitudes toward male circumcision in law, medicine, and societal opinion stand in striking contrast to the attitudes of those disciplines toward even the least invasive form of female genital alteration. US law tacitly condones male circumcision by providing exemptions that are not available for other medical procedures, while criminalizing any similar or even less extensive procedure on females. The increase in immigration, over the past few decades, of people from countries in which female genital alteration is a cultural tradition has brought the issue to the United States. The medical profession''s changing approach over time toward male circumcision is primarily responsible for such different legal and societal reactions toward female genital alteration. [Copyright &y& Elsevier]

To report clinical characteristics and outcomes of people with multiple sclerosis (PwMS) who developed COVID-19 infection in Toronto, Canada. Descriptive, retrospective, single-center study that included all known PwMS at the St. Michael's Hospital MS Clinic who had PCR-confirmed COVID-19 infection between March 2020 and May 2021. Of 7000 PwMS in our clinic, 80 (1.1%) tested positive for SARS-CoV-2. Fifty-four (67.5%) were on disease-modifying therapy (DMT) without over-representation of any single treatment. Seventy-one patients (88.8%) had mild symptoms, but nine (11.3%) were hospitalized and one 70-year-old male patient not on treatment died. Of those hospitalized, one-third were treated with ocrelizumab. In Toronto, PwMS did not appear to have higher prevalence of COVID-19 infection compared to the general population, but disease severity may be affected by DMT use. Our findings add to the accumulating global data regarding COVID-19 infection in PwMS. [ABSTRACT FROM AUTHOR]

Allergic rhinitis is a chronic inflammatory condition caused by an exaggerated response of the immune system to common allergens. Most pharmacological therapies tend to be palliative and in some cases are associated with adverse effects. There is a growing tendency for people to self-medicate with health supplements as they are generally considered safe, however clinical studies relating to their efficacy and safety are limited. This mixed-methods systematic review aims to synthesise the available evidence relating to the treatment of allergic rhinitis with a variety of health supplements. A total of 57 062 articles were derived from searching seven online databases and evidence from 48 RCTs and 10 observational studies were reviewed for methodological quality and risk of bias. No qualitative studies meeting the inclusion criteria could be found, therefore only a quantitative review was performed. Promising evidence for the following single supplements were found: apple polyphenols, tomato extract, spirulina, chlorophyll c2, honey, conjugated linoleic acid, MSM, isoquercitrin, vitamins C, D and E, as well as probiotics. Combination formulas may also be beneficial, particularly specific probiotic complexes, a mixture of vitamin D3, quercetin and Perilla frutescens, as well as the combination of vitamin D3 and L. reuteri. Owing to the paucity of good quality evidence, recommendations pertaining to the use of health supplements for allergic rhinitis should involve a shared decision-making process between the healthcare provider and the patient, taking into account their efficacy, safety and cost. Further good quality clinical studies and qualitative research would further our understanding of the role these health supplements may play in future treatment protocols. [ABSTRACT FROM AUTHOR]

The evidence on aquatic therapy (AT) for improving balance and gait deficits post-stroke is unclear. Therefore, this study aimed to determine the effect of AT on balance and gait in stroke survivors. We searched CINAHL, PubMed, Web of Science, Aqua4balance, Ewac, Cochrane, and EMBASE databases from inception to 1st November 2019. Eleven studies with 455 participants were included for the review. Meta-analysis showed that AT was effective for improving balance (MD 3.23, 95% CI 1.06, 5.39; p = 0.004; I2 = 61%) and gait speed (MD 0.77, 95% CI 0.25, 1.29; p = 0.004; I2 = 0%) when delivered alone. AT was effective in improving cadence (MD 4.41, 95% CI 0.82, 8.00; p = 0.02; I2 = 68%) when delivered as an adjunct to land-based therapy. AT may be used to improve balance and gait after stroke; however, the evidence to support its use is still low. • Aquatic therapy showed improvement in balance and gait speed among stroke survivors when delivered alone. • Aquatic therapy showed improvement in cadence among stroke survivors when delivered as an adjunct to land-based therapy. • The most reported parameters of aquatic therapy are 40–60 mins of intervention, 3-5 sessions per week for eight weeks. • Aquatic therapy may be used to improve balance, gait speed and cadence after stroke; however, the evidence is still low. • No adverse events were observed during or following aquatic therapy intervention. [ABSTRACT FROM AUTHOR]

An understanding of natural coastal hazards is essential for the safe and sustainable development of the small island states in the SouthPacific. This paper describes the roles of coastal geology and oceanography in the analysis of impacts due to fluctuating water levels and wave damage from cyclones. The examples include coastal erosion, flooding and wave damage in a range of island settings. As seen in Tarawa, rapid erosion and accretion can result from both short-lived storms as well as transient sub-decadal water-level changes related to ElNino and the Southern Oscillation (ENSO). Cyclone waves are responsible for extensive damage in low-lying atolls and on the coastal fringes of high islands. Observed cyclone wave impacts in Niue demonstratethat even infrastructure perched on 20 m cliffs may not be immune during severe storms. These examples demonstrate that integrated coastal management (ICM) plans, to be successful, must explicitly incorporate a realistic range of coastal processes and responses based on an understanding of the physical environment. It should be noted that much ICM begins with institutional and policy issues and incorporates science as a secondary component. When science is introduced, much emphasis is placed on biological issues and on infrastructure development, while non-living resources and physical shore processes are sometimes overlooked. As we hope the examples in this paper demonstrate, thegeological oceanographic context may be absolutely fundamental to the recognition of hazards, delineation of risk, and prediction of changes that may occur from any manipulation in the coastal system. [ABSTRACT FROM AUTHOR]