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Objective(s): To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics. Design: Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively. Setting: 6 UK Stroke Units Participants: 89 therapy sessions were observed, involving 55 clinicians and 57 patients. Results: Proportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1–8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset. Conclusions: To optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke. Trial registration number: Clinicaltrials.gov (NCT03792126). Contribution of the Paper: • The findings from this study highlight opportunities for therapists to consider how they use verbal instructions and feedback in a specific and precise way, in order to support the process of motor learning. There is scope within routine clinical practice to use the many and varied types of feedback more robustly. • This study provides insight into how therapists apply motor learning principles stroke rehabilitation settings, and potential associations with a range of patient characteristics.

Bruising is a commonly sustained injury in childhood, and thus is often overlooked during examination. However, it is the most common abusive injury, and may indicate severe internal injury, or precede catastrophic injury. Knowing which bruises warrant further investigation is vital to protect the child. A careful history, including developmental stage, past medical and social history followed by a full top to toe examination is required. Evidence highlights that some patterns of bruising warrant further investigation. This includes bruising in young, immobile infants, or bruising to the cheeks, ears, neck, trunk, genitalia or multiple bruises from a single incident, particularly in a distinct pattern or accompanying petechiae. Full assessment includes obtaining high quality clinical photographs of the bruising, exclusion of underlying bleeding disorders, consideration of differential diagnosis, and assessment for occult injury. The latter should include a skeletal survey in those aged less than two years, and computerized tomography of brain and full ophthalmology examination for those aged less than one year. Discussion with senior colleagues, consideration of the safety of the child, and clear communication with the family is vital throughout this process. Acting promptly and appropriately when concerning bruises are found may be the only opportunity to protect this child from further harm.

To compare quality of life in children and adolescents with tibial fracture during treatment with either a definitive long-leg cast or Ilizarov frame.A prospective, longitudinal cohort study was undertaken. Patients aged between 5 and 17 years with tibial fractures treated definitively using a long-leg cast or Ilizarov frame were recruited at first follow-up. Health related quality of life was measured at each clinic appointment during treatment using the Pediatric Quality of Life Inventory (PedsQL) [1]; a validated measure of age-adjusted physical and psychosocial functioning. Psychological trauma symptoms were assessed using the Children's Revised Impact of Events Scale (CRIES) [2]. Results were analysed based on time from injury (less than 30 days, 30 to 120 days). Data regarding injury and treatment was recorded from the clinical records. Statistical analysis was undertaken using a Kruksal-Wallis test with a Tukey-Kramer subgroup analysis.Twenty-five patients from each group were included in the final analysis. Injuries were more severe in the frame patients based on the AO/OTA classification and number of open fractures. No statistically significant differences were detected in any of the outcome scores between treatment groups at either time point. A significant improvement was found in the child reported physical and total domains in both treatment groups based on time from application (30 days vs.30 days, frame: p 0.0001, cast: p = 0.003). There were no differences in the child reported psychosocial domain scores at any time point or between treatment groups. Parent reported scores only showed a significant physical improvement in the frame group (p 0.0001). CRIES scores for psychological trauma in the intrusion and avoidance domain improved significantly in the cast group between time points (p 0.05), Multivariate analysis identified polytrauma, mechanism of injury and time from injury but not treatment modality (cast or frame) as significant predictors of quality of life scores (PedsQL) and severity of post-traumatic symptoms (CRIES).We found no difference in health-related quality of life during treatment between our patients treated for tibial fractures using a cast or an Ilizarov frame.

Objective: To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes.\ud Study design: A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH

STUDY QUESTION: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise and consumer preference?SUMMARY ANSWER: International evidence-based guidelines, including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS.WHAT IS KNOWN ALREADY: Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial, and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist.STUDY DESIGN, SIZE, DURATION: International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength.PARTICIPANTS/MATERIALS, SETTING, METHODS: Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. In total, 37 societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels.MAIN RESULTS AND THE ROLE OF CHANCE: The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: (i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; (ii) reducing unnecessary testing; (iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and (iv) emphasizing evidence based medical therapy and cheaper and safer fertility management.LIMITATIONS, REASONS FOR CAUTION: Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided.WIDER IMPLICATIONS OF THE FINDINGS: The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program.STUDY FUNDING/COMPETING INTEREST(S): The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE-II criteria, and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC.

To inform childhood burn prevention by identifying demographics, clinical features and circumstances of unintentional non-scald burns.A prospective cross-sectional study was conducted across Cardiff, Bristol and Manchester, including six emergency departments, three minor injury units and one burns unit between 13/01/2013-01/10/2015. Data collected for children aged16 years with any burn (scald, contact, flame, radiation, chemical, electrical, friction) included: demographics, circumstances of injury and clinical features. Scalds and burns due to maltreatment were excluded from current analysis.Of 564 non-scald cases, 60.8% were boys, 51.1% were3 years old, 90.1% (472/524) of burns affected one anatomical site. Contact burns accounted for 86.7% (489/564), 34.8% (137/394) of which were from objects placed at0.6m and 76.5% (349/456) affected the hands. Hairstyling devices were the most common agent of contact burns (20.5%, 100/487); 34.1% (30/88) of hairstyling devices were on the floor. Of children aged 10-15 years, 63.7% (65/102), sustained contact burns of which 23.2% (13/56) were preparing food, and when burnt from hairstyling devices, 73.3% (11/15) were using them at the time of injury.Parents of toddlers must learn safe storage of hazardous items. Older children should be taught skills in safe cooking and hairstyling device use.

Indigenous people worldwide have a greater disease burden than their non-aboriginal counterparts with health challenges that include increased obesity and higher prevalence of diabetes. We investigate the relationships of dietary patterns with nutritional biomarkers, selected environmental contaminants and measures of insulin resistance in the Cree (Eeyouch) of northern Québec Canada.The cross-sectional 'Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Eeyou Istchee' recruited 835 adult participants (≥18 y) from 7 communities in the James Bay region of northern Québec. The three dietary patterns identified by principal component analysis (PCA) were: inland and coastal patterns with loadings on traditional foods, and a junk food pattern with high-fat and high-sugar foods. We investigated dietary patterns scores (in quantiles) in relation with nutritional biomarkers, environmental contaminants, anthropometry, blood pressure, fasting plasma glucose and insulin, and insulin resistance. Homeostatic model assessment (HOMA-IR) was used as surrogate markers of insulin resistance. ANCOVA ascertained relationships between dietary patterns relationship and outcomes. Greater scores for the traditional patterns were associated with higher levels of n-3 fatty acids, mercury and polychlorinated biphenyls (PCBs) (P trend0.001). Higher scores for the junk food pattern were associated with lower levels of PCBs and Vitamin D, but higher fasting plasma insulin and HOMA-IR.Our results suggest that poor diet quality accompanied greater insulin resistance. Impacts of diet quality on insulin resistance, as a sign of metabolism perturbation, deserve more attention in this indigenous population with high rates of obesity and diabetes.

Objective To explore knowledge about the effects on fertility of age, obesity, smoking, and timing of intercourse among Australians of reproductive age. Design Telephone survey of a representative sample of Australians. Setting Not applicable. Patient(s) Australians aged 18 to 45 years who wish to have a child or another child now or in the future. Intervention(s) None. Main Outcome Measure(s) Knowledge about the effect on fertility of age, obesity, smoking, and timing of intercourse. Result(s) A total of 462 interviews were conducted. The majority of respondents underestimated, by about 10 years, the age at which male and female fertility starts to decline. Only one in four correctly identified that female fertility starts to decline before age 35, and one in three identified that male fertility starts to decline before age 45. Most (59%) were aware that female obesity and smoking affect fertility, but fewer recognized that male obesity (30%) and smoking (36%) also influence fertility. Almost 40% of respondents had inadequate knowledge of when in the menstrual cycle a woman is most likely to conceive. Conclusion(s) Considerable knowledge gaps about modifiable factors that affect fertility were identified. These are targeted in a national education campaign to promote awareness of factors that influence fertility.

Food insecurity and the nutrition transition have been noted in arctic communities. We therefore evaluated biomarkers of nutritional status and nutrient intakes by traditional food (TF) and food security status among Inuit in Canada. A cross-sectional health survey of Inuit (≥18 y) in 36 arctic communities was conducted in 2007-2008. Food security was assessed by 24-h dietary recalls using USDA questionnaires and nutrient intakes. Biomarkers included serum 25-hydroxy vitamin D [25(OH)D], hemoglobin, serum ferritin, and erythrocyte RBC fatty acids (FA). Analyses were stratified by past-day TF consumption (yes vs. no) and food security status (secure vs. insecure). Food insecurity was prevalent (62.6%) and associated with higher RBC trans-FA and lower hemoglobin levels and serum ferritin, whereas TF consumption was associated with higher serum 25(OH)D, (n-3) FA, and serum ferritin (P ≤ 0.05). In men, food insecurity was associated with lower intake of energy and energy-adjusted fiber, vitamin C, iron, zinc, and magnesium. In women, food insecurity was associated with a higher intake of carbohydrates and lower intake of fiber, dietary folate equivalent, vitamin C, iron, magnesium, calcium, and vitamin D. For both sexes, when TF was consumed, there was a higher intake of protein, protein-related micronutrients, and vitamins A and C and a lower intake of carbohydrates, saturated fat, and fiber and a lower sodium:potassium ratio (P ≤ 0.05). Nutrition transition and food insecurity are associated with a multifaceted shift in nutrient status and intakes with implications for increased risk of diet-sensitive chronic diseases.

The exocyclic analogue of the indole alkaloid isolated from the marine sponge Halichondria melanodocia has been prepared via olefination of a phosphonoester derived from 3-(2-bromoacyl)indole. The formation of an unexpected indolylazepine is also discussed.

Barettin (cyclo [(6-bromo-8-en-tryptophan) arginine]), a diketopiperazine isolated from the marine sponge Geodia barretti, is a potent inhibitor of barnacle larvae settlement with an EC50-value of 0.9 microM. In the present study, 14 analogs of barettin and its structural congener dipodazine were synthezised and tested for their ability to inhibit larval settlement. Two of the analogs have an intact barettin skeleton. The remaining analogs have a dipodazine skeleton (a diketopiperazine where arginine is replaced with glycine). Six of the tested synthetic analogs displayed significant settlement inhibition with the most potent inhibitor being benzo[g]dipodazine, which displayed even stronger activity than barettin (EC50-value 0.034 microM). The effect of benzo[g]dipodazine was also shown to be readily reversible, when cyprids were transferred to filtered seawater (FSW).

This study provides comprehensive documentation of silk production in the pest moth Helicoverpa armigera from gland secretion to extrusion of silk thread. The structure of the silk glands, accessory structures and extrusion apparatus are reported. The general schema of the paired silk glands follows that found for Lepidoptera. Morphology of the duct, silk press, muscle attachments and spigot are presented as a three-dimensional reconstruction and the cuticular crescent-shaped profile of the silk press is demonstrated in both open and closed forms with attendant muscle blocks, allowing advances in our knowledge of how the silk press functions to regulate the extrusion of silk. Growth of the spigot across instars is documented showing a distinctive developmental pattern for this extrusion device. Its shape and structure are related to use and load-bearing activity.

Background and purpose The Modified Rivermead Mobility Index (MRMI) is a newly developed outcome measure that aims to evaluate the effectiveness of physiotherapy on mobility following stroke. Any new measurement tool requires extensive testing of its validity and reliability before it can be recommended for use in clinical practice or research. The purpose of this study was to investigate the concurrent validity of the MRMI when measuring mobility in patients who have had a stroke. The internal consistency and test administration times of the MRMI and Motor Assessment Scale (MAS) were also investigated. Methods Twenty-six hospitalised acute/sub-acute stroke patients from the Medical and Elderly wards of a General Hospital in West Yorkshire were assessed independently with the MRMI and MAS. Test administration time was also recorded. Results Limits of agreement indicated that on average subjects scored three points higher on the MRMI than the MAS (mobility-related items). Ninety-five percent of subjects scored between one point lower and seven points higher on the MRMI than the MAS. Both scales possessed high internal consistency (MRMI α =0.949 and MAS α =0.953). Individual items also possessed high internal consistency (MRMI α =0.743–0.959, MAS=0.854–0.893) except the sitting balance items (MRMI α =0.304 and MAS α =0.545). Both scales took an average of 17min to administer. Conclusions The mean difference between scores on the MRMI and MAS was small enough to allow clinicians to use either scale to measure mobility in stroke patients. Both scales possessed high internal consistency except the sitting balance items that may be measuring a different construct to mobility. The MRMI and MAS are sufficiently quick to administer to advocate use in routine clinical practice.

The indole alkaloid barettin (with bromine in 6-position), isolated from the marine sponge Geodia Barretti, has been synthesised via a Horner-Wadsworth-Emmons type reaction from 6-bromoindole-3-car ...

Fortification with calcium to increase dietary intakes of this mineral is currently under evaluation in Canada. To model the potential dietary consequences of food fortification, data from a large national survey of Canadians (n = 1543) were used. Food fortification scenarios were based on reference amounts for labeling requirements. Consumption of milk, cheese and other dairy products was associated with high calcium intakes, and there was a low prevalence of inadequacy in men < 50 y old; however, other age-sex groups had lower intakes. The aim of the fortification modeling was to determine which scenario would most effectively reduce the proportion of the population with low intakes of calcium while minimizing the proportion of individuals who exceeded the tolerable upper intake level (UL). Given the correlation between energy and calcium (r = 0.60, P < 0.01), it appeared that any fortification scenario sufficient to increase the mean intake for women to near the adequate intake led to 6-7% of the men having calcium intakes above the UL. The results suggest that fortification of widely consumed foods is not a realistic way to address the issue of low calcium intakes and illustrate the need for concern about the growing use of fortification practices.

The total synthesis of all four known rhopaladins, A-D, isolated from the Okinawan marine tunicate Rhopalaea sp., in two synthetic steps is described, involving an imidate based cyclization with tryptophan esters as the key step to afford the appropriately substituted imidazolinone unit. A short and efficient new synthesis of indol-3-yl-carbonyl nitriles from indol-3-yl-carboxaldehydes and trimethylsilyl cyanide, followed by oxidation with DDQ is also described.

An oxymoron by definition is a paradox, a universal contradiction. But no words or concepts have such stability. Indeed, any concept subject to a feminist critique is quickly revealed as a social construction whose so-called paradoxical status is but the beginning of redefinition and the foundation for political action. So it is with academic feminism. While apparently a contradiction to ‘teach’ feminism within an exclusive authoritarian academy awash with masculine ways of knowing and doing, my experience in Women's Studies at Deakin University has revealed the positive as well as the negative sides of this paradox. In particular, by subverting the academy as the sole custodian of ‘higher learning,’ in confronting men's knowledge with the possibility of feminist knowledge, and in juxtaposing feminist ways of working and organising with pre-existing structures of power and status (even if without success), avenues of redefinition and political action have been exposed which undermine academic feminism as an oxymoron.