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Introduction: Post-stroke fatigue (PSF) is common and debilitating. However, while its effective management is a priority for clinicians and stroke survivors, there remains little evidence to provide guidance or underpin practice. Our aim, therefore, was to gain insights into the experiences of clinicians who routinely manage patients with fatigue. Method: Qualitative interview study. The target was to recruit a purposeful sample of approximately 20 participants with expertise in managing PSF and fatigue arising from other conditions. Maximum variation sampling was used to ensure a balance of participants across different settings. Data were analysed using a framework approach, iteratively developed and refined by including emergent themes. Results: We recruited 20 participants: nine occupational therapists (OTs), five physiotherapists, three nurses and three psychologists, which included three 'fatigue experts' from Europe and Australia. Analysis generated core themes around management and strategies used; these were similar regardless of professional background, clinical or geographical setting or condition treated. OTs felt a particular responsibility for fatigue management, although multidisciplinary teamwork was stressed by all. Conclusion: There are clear similarities in clinicians' experiences of managing PSF and fatigue across different conditions and also across professional groups. Clinicians rely predominantly on their own clinical knowledge for guidance. [ABSTRACT FROM AUTHOR]

The Heihe River Basin in Northwestern China depends heavily on both manmade and natural storage (e.g., surface reservoirs, rivers, and groundwater) to support economic and environmental functions. The Qilian Mountain cryosphere in the upper basin is integral to recharging these storage supplies. It is well established that climate warming is driving major shifts in high elevation water storage through loss of glaciers and permafrost. However, the impacts on groundwater-surface water interactions and water supply in corresponding lower reaches are less clear. We built an integrated hydrologic model of the middle-basin, where most water usage occurs in order to explore the hydrologic response to cryosphere trends. We simulate watershed response to loss of glaciers (Glacier scenario), advanced permafrost degradation (Permafrost scenario), both responses (Combined scenario) and projected temperature increases in the middle basin (Warming scenario) by altering streamflow inputs to the model to represent cryosphere melting processes, as well as by increasing the temperature of the climate forcing data. Net losses to groundwater storage in the Glacier scenario and net gains in Permafrost and Combined show the potential of groundwater exchanges to mediate streamflow shifts. The result of the Combined scenario also shows that permafrost degradation has more of an impact on the system than glacial loss. Seasonal differences in groundwater-surface water partitioning are also evident. The Glacier scenario has the highest fraction of groundwater in streamflow in early spring. The Permafrost and Combined scenarios meanwhile have the highest fraction of streamflow entering the subsurface in late spring and summer. The Warming scenario raises the temperature of the Combined scenario by 2C. A reversal in trend to net groundwater storage loss, and large seasonal changes in evapotranspiration and stream network connectivity relative to Combined show the potential for warming to overpower changes resulting from streamflow. Our results demonstrate the importance of understanding the entire system of groundwater-surface water exchanges to assess water resources under changing climatic conditions. Ultimately, this analysis can be used to examine the cascading impact of climate change in the cryosphere on the resilience of water resources in arid basins downstream of mountain ranges globally. [ABSTRACT FROM AUTHOR]

The purpose of this study was twofold: to examine predictors of disordered eating behaviours and body image dissatisfaction, including social networking, among type 1 diabetes population, and to qualitatively explore the relationship between type 1 diabetes management and body image. A convenience sample of 121 type 1 diabetes patients (F = 106; M age = 36 ± 6.5) was collected via online questionnaires, of which 98 patients responded to two open-ended questions. Young age and negative body image explained 58.8 per cent of disordered eating variance, while body weight and social networking negatively contributed to poor body image (29.9%). Qualitative analysis revealed three themes: no control over body weight, limitation in clothing options and discomfort towards medical equipment. [ABSTRACT FROM AUTHOR]

Psychoeducation can provide information and support to cope with the physical and emotional effects of a health condition. This scoping review aimed to identify the evidence regarding psychoeducational interventions for people after a Transient Ischemic Attack (TIA) and minor stroke. This review was conducted in accordance with the PRISMA Extension for Scoping Reviews. Three electronic databases (MEDLINE, Embase, PsycINFO) were searched for articles on interventions related to psychoeducational support post-TIA and minor/mild stroke. Search retrieved 3722 articles. Three reviewers independently screened titles, abstracts, full-texts, and extracted data for included studies. Study quality was assessed using the JADAD scale. TIDieR checklist was used to describe interventions. Fifteen RCTs were included. Twelve studies were of high quality (JADAD score ≥2), two were of low quality. A total of 1500 participants were recruited across studies. Definition of TIA and minor stroke was unclear, leading to the exclusion of several studies. Various interventions were included, including education/psychoeducation (n = 4); exercise and lifestyle advice (n = 3); telephone-based education/counseling (n = 3); secondary prevention education (n = 1); motivational interviewing (n = 2); self-management (n = 2). Interventions were inconsistently described, with information missing about who delivered it and tailoring. Definitions of stroke severity are not adequately reported. There are a variety of interventions including education about a range of stroke-specific topics. Many interventions are not adequately described, thus making it difficult to determine if the aim was to provide information or support post-TIA/minor stroke. There is a need for an in-depth systematic review to develop a clear definition of psychoeducation. [ABSTRACT FROM AUTHOR]

Recent advancements in computational efficiency and earth system modeling have awarded hydrologists with increasingly high-resolution models of terrestrial hydrology, which are paramount to understanding and predicting complex fluxes of moisture and energy. Continental-scale hydrologic simulations are, in particular, of interest to the hydrologic community for numerous societal, scientific and operational benefits. The coupled hydrology-land surface model ParFlow-CLM configured over the continental United States (PFCONUS) has been employed in previous literature to study scale-dependent connections between water table depth, topography, recharge, and evapotranspiration, as well as to explore impacts of anthropogenic aquifer depletion to the water and energy balance. These studies have allowed for an unprecedented, process-based understanding of the continental water cycle at high resolution. Here, we provide the most comprehensive evaluation of PFCONUS version 1.0 (PFCONUSv1) performance to date, comparing numerous modeled water balance components with thousands of in situ observations and several remote sensing products, and using a range of statistical performance metrics for evaluation. PFCONUSv1 comparisons with these datasets are a promising indicator of model fidelity and ability to appropriately reproduce the continental-scale water balance at high resolution. Areas for improvement are identified, such as a positive streamflow bias at gauges in the eastern Great Plains, a shallow water table bias over many areas of the model domain, and low bias in seasonal total water storage amplitude especially for the Ohio, Missouri and Arkansas river basins. We discuss several potential sources for model bias and suggest that minimizing error in topographic processing and meteorological forcing would considerably improve model performance. Results here provide a benchmark and guidance for further PFCONUS model development, and they highlight the importance of concurrently evaluating all hydrologic components and fluxes to provide a multivariate, holistic validation of the complete modeled water balance. [ABSTRACT FROM AUTHOR]

Topography is a fundamental input to hydrologic models critical for generating realistic streamflow networks as well as infiltration and groundwater flow. Although there exist several national topographic datasets for the United States, they may not be compatible with gridded models that require hydrologically consistent Digital Elevation Models (DEMs). Here, we present a national topographic dataset developed support physically based hydrologic simulations at 1km and 250m spatial resolution over contiguous United States. The workflow is described step-by-step in two parts (a) DEM processing using a Priority Flood algorithm to ensure hydrologically consistent drainage networks and (b) slope calculation and smoothing to improve drainage performance. The accuracy of derived stream network is evaluated by comparing the derived drainage area to drainage areas reported by the national stream gage network. The slope smoothing steps are evaluated using the runoff simulations with an integrated hydrologic model. The processed DEM is designed to capture the topographic features and improve the runoff simulations for the models solving partial differential equations. The workflow uses an open-source R package and all output datasets and processing scripts are available and fully documented here. All of the output datasets and scripts for processing are published through Cyverse at 250m and 1km resolution. [ABSTRACT FROM AUTHOR]