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To test the hypothesis that a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence of wheelchair service providers, and to determine the participants' views on the Course. This was an observational cohort study, with pre-post comparisons. To meet the objectives of the six-week Course, the curriculum included self-study and weekly one-hour remote meetings. Participants submitted their Wheelchair Skills Test Questionnaire (WST-Q) (Version 5.3.1) "performance" and "confidence" scores before and after the Course. Participants also completed a Course Evaluation Form after the Course. The 121 participants were almost all from the rehabilitation professions, with a median of 6 years of experience. The mean (SD) WST-Q performance scores rose from 53.4% (17.8) pre-Course to 69.2% (13.8) post-Course, a 29.6% relative improvement (p < 0.0001). The mean (SD) WST-Q confidence scores rose from 53.5% (17.9) to 69.5% (14.3), a 29.9% relative improvement (p < 0.0001). Correlations between performance and confidence were highly significant (p < 0.0001). The Course Evaluation indicated that most participants found the Course useful, relevant, understandable, enjoyable, "just right" in duration, and most stated that they would recommend the Course to others. Although there is room for improvement, a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%, and participants were generally positive about the Course. A Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%. Participants were generally positive about the Course. [ABSTRACT FROM AUTHOR]

To test the hypotheses that, in comparison with pushing an occupied upright manual wheelchair forward, pulling backward on the push-handles improves the objective and subjective ease with which a caregiver can get the wheelchair across a soft surface (e.g., grass, mud, sand, gravel); and the ease with which a caregiver can get the wheelchair across a soft surface improves if the wheelchair is tipped back into the wheelie position. We used a randomized crossover trial with within-participant comparisons to study 32 able-bodied pairs of simulated caregivers and wheelchair occupants. The caregiving participants moved an occupied manual wheelchair 5 m across a soft surface (7.5-cm-thick gym mats) under four conditions (upright-forward, upright-backward, wheelie-forward and wheelie-backward) in random order. The main outcome measure was time (to the nearest 0.1 s) and the main secondary measure was the ease of performance (5-point Likert scale). The upright-backward condition was the fastest (p < 0.05) and had the highest ease-of-performance scores. In the forward direction, there was no statistically significant difference in the time required between the upright and wheelie positions, but the wheelie position was considered easier. Although further study is needed, our findings suggest that caregivers should pull rather than push occupied wheelchairs across soft surfaces. In the forward direction, caregivers may find the wheelie position easier than the upright condition. These techniques have the potential to both improve the effectiveness of and reduce injuries to caregivers. Clinical Trial Registration Number: NCT 04998539 Caregivers should pull rather than push occupied manual wheelchairs across soft surfaces. In the forward direction, caregivers may find the wheelie position easier than and preferable to the upright condition. These techniques have the potential to both improve the effectiveness of and reduce injuries to caregivers. [ABSTRACT FROM AUTHOR]

Objective(s): Life and limb threatening vascular emergencies often present to rural hospitals where only general surgery services are available. It is known that Australian rural general surgical centres encounter 10–20 emergency vascular surgery procedures annually. This study aimed to assess rural general surgeons' confidence managing emergent vascular procedures. Setting, Participants and Design: A survey was distributed to Australian rural general surgeons to determine their confidence (Yes/No) in performing emergent vascular procedures including limb revascularisation, revising arterio‐venous (AV) fistulas, open repair of ruptured abdominal aortic aneurysm (AAA), superior mesenteric artery (SMA)/coeliac embolectomy, limb embolectomy, vascular access catheter insertion and limb amputation (digit, forefoot, below knee and above knee). Confidence level was compared with surgeon demographics and training. Variables were compared using univariate logistic regression. Results: Sixteen per cent (67/410) of all Australian rural general surgeons responded to the survey. Increased age, years since fellowship and training prior to 1995 (when separation of Australian vascular and general surgery occurred) were associated with greater confidence in limb revascularisation, revising AV fistulas, open repair of ruptured AAA, SMA/coeliac embolectomy, and limb embolectomy (p < 0.05). Surgeons who completed >6 months of vascular surgery training were more comfortable with SMA/coeliac embolectomy (49% vs. 17%, p = 0.01) and limb embolectomy (59% vs. 28%, p = 0.02). Confidence in performing limb amputation was similar across surgeon demographics and training (p > 0.05). Conclusion: Recently graduated rural general surgeons do not feel confident in managing vascular emergencies. Additional vascular surgery training should be considered as part of general surgical training and rural general surgical fellowships. [ABSTRACT FROM AUTHOR]

Abstract Purpose Methods Results Conclusion \nThe Wheelchair Skills Test (WST) is commonly conducted in a simulated setting. Although the WST can be done in the community setting, its usefulness in this setting has not been systematically evaluated. The purpose of this study was to compare the WST in the simulated versus community settings, and to explore participants’ perceptions of performing in each environment.For this mixed-methods study, we studied 20 motorized mobility scooter users who had used their devices for ≥ 3 months. Each participant completed the WST Version 4.3 twice in random order – once in a simulated setting and once in their community within a two-week period. Semi-structured interviews were conducted after completion of the WST in both environments. A self-report version of the WST (WST-Q) was also completed that measured perceived capacity, frequency of skill performance, and confidence.The mean (SD) total WST score in the simulated setting was 88.9% (8.6) and 92.7% (7.8) in the community setting. The two WST scores were moderately correlated (r = 0.306, p = 0.190). Community-setting WST scores were moderately correlated with WST-Q confidence scores. Simulated-setting scores were moderately correlated with WST-Q frequency scores. Although most participants preferred performing the WST in their communities due to convenience and familiarity, they perceived the simulated setting to be reflective of their community settings.Despite challenges, community-based testing may provide a better reflection of everyday performance for scooter users than testing in a simulated environment.Wheelchair Skills Test (WST) scores obtained from conducting the assessment in the community may be different from those obtained from conducting the assessment in a simulated setting.Since the WST conducted in the community likely provides different information from the WST conducted in the lab, clinicians should carefully consider which environment to access wheelchair skills in.In an urban, community setting, all WST skills were able to be found within a one block radius of participants’ homes. [ABSTRACT FROM AUTHOR]

Introduction: Valid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals' (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test's psychometric properties, 2) to develop the test's Version 2, and 3) to evaluate the content validity of the new version. Methods: For Objective 1, methods from the Classical Test Theory were used to obtain items' difficulty, item discrimination index and domains' reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions' text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity. Results: For Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped. Conclusion: The psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored. [ABSTRACT FROM AUTHOR]

To explore the experiences of new motorised mobility scooter users from the perspectives of the assessment and training of scooter skills. Descriptive secondary analysis of qualitative data. Community. 20 New users of motorised mobility scooters. Not applicable. Directed qualitative analysis of up to four semi-structured interviews over the course of the first year of scooter use, to identify themes and sub-themes that could inform recommendations regarding assessment and training protocols. We identified two themes. The first related to potential new content. As one example of the sub-themes, there were many excerpts that dealt with the use of skills in various combinations and permutations that were used to carry out activities during everyday life and participate in society. These excerpts suggested the importance of training skills in combination to facilitate skill transfer (or generalizability). The second theme is related to enhancements of existing content. As one example of the sub-themes, there were several excerpts that dealt with scooter security. These excerpts led to the recommendation that removing and inserting the scooter key should be added to the assessment criteria for the "turns power on and off" skill of the Wheelchair Skills Test (WST) and its questionnaire version (WST-Q). The experiences of scooter users over the first year of receiving a scooter appear to be relevant to the assessment and training of scooter skills and suggest themes for further study. Clinical trial registration number: NCT02696213 The experiences of new scooter users are highly relevant to the assessment and training of scooter skills. These experiences suggest both potential new content and enhancements of existing content to the Wheelchair Skills Program Manual. [ABSTRACT FROM AUTHOR]

To test the hypothesis that remote learning to teach clinicians manual wheelchair skills is efficacious. A convenience sample of therapists (physical and occupational) and students were enrolled in pairs in a cohort study with pre- versus post-training comparisons. The intervention was a hybrid of self-study and hands-on practice paired with remote feedback for ten intermediate and advanced manual wheelchair skills. Participants practiced with self-selected frequency and duration, uploading a session log and video(s) to an online platform. A remote trainer provided asynchronous feedback prior to the next practice session. Capacity and confidence in completing the ten skills were evaluated using the Wheelchair Skills Test Questionnaire (WST-Q). Knowledge of wheelchair skills training and motor learning was assessed using a 62-item Knowledge Test. Secondary outcome measures included skill achievement, as confirmed by submitted video recordings, and participant feedback about the training. Across 41participants, scores were higher at follow-up compared to baseline for WST-Q capacity (73.9 ± 19.1 vs 16.8 ± 15.6, p < 0.001), WST-Q confidence (80.1 ± 12.2 vs 47.6 ± 18.2, p = 0.003) and knowledge (70.8 ± 7.5 vs 67.0 ± 5.4, p = 0.004). Remote learning can increase wheelchair skills capacity and confidence as well as knowledge about such training and assessment. This model should be further investigated as a delivery method for training rehabilitation professionals. NCT01807728. Wheelchair skills training is one of the 8 steps of wheelchair provision as outlined by the World Health Organization. Wheelchair skills are not a core part of most clinical curriculums and many clinicians cite a lack of resources and uncertainty on how to implement wheelchair skills training into practice as major barriers to providing such training. Remote learning offers the benefits of structured wheelchair skills training with expert feedback on an individual's own schedule that is not afforded by one-day "bootcamp"-type courses or on-the-job training, which are how many clinicians currently learn wheelchair skills. In a sample of physical and occupational therapists and students, remote learning was effective at increasing capacity and confidence to perform manual wheelchair skills as well as knowledge of wheelchair training. [ABSTRACT FROM AUTHOR]

(b) (right): Ultrasound long-view of the right testis, located in the hemiscrotum. gl Subsequent examination by a urologist confirmed the presence of a normal right testis and an undescended left inguinal testis. Benign ultrasound in a young adult with pT2 seminoma - beware the malignant potential of undescended testes Undescended testicles (UDTs) in post-pubertal males, while uncommon in high-income countries, pose a serious risk of malignancy if undetected.[[1]] While most will descend spontaneously during the first year of life (only 1% of boys have UDT at 12-months of age), they may pose a risk of malignancy if left untreated. [Extracted from the article]

Bacteria encased in a biofilm poses significant challenges to successful treatment, since both the immune system and antibiotics are ineffective. Sonobactericide, which uses ultrasound and microbubbles, is a potential new strategy for increasing antimicrobial effectiveness or directly killing bacteria. Several studies suggest that sonobactericide can lead to bacterial dispersion or sonoporation (i.e., cell membrane permeabilization); however, real-time observations distinguishing individual bacteria during and directly after insonification are missing. Therefore, in this study, we investigated, in real-time and at high-resolution, the effects of ultrasound-induced microbubble oscillation on Staphylococcus aureus biofilms, without or with an antibiotic (oxacillin, 1 μg/mL). Biofilms were exposed to ultrasound (2 MHz, 100–400 kPa, 100–1000 cycles, every second for 30 s) during time-lapse confocal microscopy recordings of 10 min. Bacterial responses were quantified using post hoc image analysis with particle counting. Bacterial dispersion was observed as the dominant effect over sonoporation, resulting from oscillating microbubbles. Increasing pressure and cycles both led to significantly more dispersion, with the highest pressure leading to the most biofilm removal (up to 83.7%). Antibiotic presence led to more variable treatment responses, yet did not significantly impact the therapeutic efficacy of sonobactericide, suggesting synergism is not an immediate effect. These findings elucidate the direct effects induced by sonobactericide to best utilize its potential as a biofilm treatment strategy. [ABSTRACT FROM AUTHOR]

Background: Male circumcision is one of the most common surgical procedures performed in the Australian private sector. This study examines the trends in childhood circumcision throughout the early 21st century. Methods: Circumcisions performed between 2000 and 2019 amongst preschool‐aged Australian boys (0–4 years) were obtained from the Medicare Benefits Schedule. Quarterly data for Victoria and South Australia were divided into three phases separated by (i) state‐wide bans of non‐therapeutic circumcision in the public sector (2007) and (ii) a disfavouring of non‐therapeutic circumcisions by the Royal Australasian College of Physicians (2010). Interrupted time series analyses determined differences between pre‐ban (2000–2007), post‐ban (2007–2010) and reversal (2010–2019) phases. Results: Altogether, 478 717 circumcisions were performed on preschool‐aged boys. Incidence progressed from 2675 per 100 000 preschoolers in 2000 to 3140 in 2008 to 1875 in 2019. In Victoria, the baseline (Q1‐2000) rate of circumcision was 294.9 per 100 000. This rose by +1.3 (1.1 to 4.1, p < 0.001) per quarter pre‐ban and +6.6 (3.0 to 10.3, p = 0.001) post‐ban before decreasing by −13.1 (−16.4 to −9.8, p < 0.001) in the reversal phase. In South Australia, the initial rate was 745.2 per 100 000 and increased by +1.4 (0.0 to 2.8, p = 0.045) per quarter pre‐ban, +7.6 (0.5 to 14.7, p = 0.035) post‐ban and retracted by −20.8 (−27.9 to −13.7, p < 0.001) during the reversal phase. Conclusion: The incidence of childhood circumcisions in Australia observed a significant rise and fall throughout the early 21st century. Medical and surgical authorities may have played an important role in the gradual reduction of procedures over the last decade. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus biofilms are a major problem in modern healthcare due to their resistance to immune system defenses and antibiotic treatments. Certain analgesic agents are able to modulate S. aureus biofilm formation, but currently no evidence exists if paracetamol, often combined with antibiotic treatment, also has this effect. Therefore, we aimed to investigate if paracetamol can modulate S. aureus biofilm formation. Considering that certain regulatory pathways for biofilm formation and virulence factor production by S. aureus are linked, we further investigated the effect of paracetamol on immune modulator production. The in vitro biofilm mass of 21 S. aureus strains from 9 genetic backgrounds was measured in the presence of paracetamol. Based on biofilm mass quantity, we further investigated paracetamol-induced biofilm alterations using a bacterial viability assay combined with N-Acetylglucosamine staining. Isothermal microcalorimetry was used to monitor the effect of paracetamol on bacterial metabolism within biofilms and green fluorescent protein (GFP) promoter fusion technology for transcription of staphylococcal complement inhibitor (SCIN). Clinically relevant concentrations of paracetamol enhanced biofilm formation particularly among strains belonging to clonal complex 8 (CC8), but had minimal effect on S. aureus planktonic growth. The increase of biofilm mass can be attributed to the marked increase of N-Acetylglucosamine containing components of the extracellular matrix, presumably polysaccharide intercellular adhesion. Biofilms of RN6390A (CC8) showed a significant increase in the immune modulator SCIN transcription during co-incubation with low concentrations of paracetamol. Our data indicate that paracetamol can enhance biofilm formation. The clinical relevance needs to be further investigated. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In children, intravenous therapy (IVT) is generally administered via peripheral intravenous catheters (PIVCs) (2-6 cm in length). There is evidence that PIVCs are unreliable after 2 days. Long peripheral catheters (LPCs) (6-15 cm in length) could improve the delivery of IVT. The aim of this trial was to determine if LPCs could decrease catheter failure and the number of catheters in children receiving multiday IVT. METHODS: This was an open-label randomized controlled trial conducted at Monash Children's Hospital in Melbourne, Australia. Participants were from the ages of 1 to 17 years, undergoing surgery and requiring >48 hours of postoperative IVT. Participants were randomly assigned to a 2.5-cm 22G PIVC or an 8-cm 22G LPC. RESULTS: Seventy-two children were randomly assigned, 36 received PIVCs, and 36 received LPCs. The median duration of IVT was 5.1 days and was similar between groups (P = .9). Catheter failure was higher for PIVCs than LPCs (66.7% vs 19.4%; relative risk [RR]: 3.4; P = .0001 or 187.9 vs 41.0 failures per 1000 catheter-days). Infiltration was the most common reason for PIVC failure (33.3% vs 2.8%; RR: 12.0; P = .001). LPCs exhibited superior life span (4.7 vs 3.5 days [median]; P = .01). Children with LPCs were twice as likely to complete therapy with a single catheter (80.6% vs 38.9%; RR: 2.1; P = .0006). CONCLUSIONS: LPCs reduce catheter failure and total catheters in children. They should be considered as the first-line device for peripheral access in any child receiving prolonged IVT. [ABSTRACT FROM AUTHOR]

Ultrasound has been developed as both a diagnostic tool and a potent promoter of beneficial bio-effects for the treatment of chronic bacterial infections. Bacterial infections, especially those involving biofilm on implants, indwelling catheters and heart valves, affect millions of people each year, and many deaths occur as a consequence. Exposure of microbubbles or droplets to ultrasound can directly affect bacteria and enhance the efficacy of antibiotics or other therapeutics, which we have termed sonobactericide. This review summarizes investigations that have provided evidence for ultrasound-activated microbubble or droplet treatment of bacteria and biofilm. In particular, we review the types of bacteria and therapeutics used for treatment and the in vitro and pre-clinical experimental setups employed in sonobactericide research. Mechanisms for ultrasound enhancement of sonobactericide, with a special emphasis on acoustic cavitation and radiation force, are reviewed, and the potential for clinical translation is discussed. [ABSTRACT FROM AUTHOR]

Purpose: Although both wheelchair skills and fitness are important and probably inter-related, the extent and nature of the relationship between them are not well understood. The objective of this study was to test the hypothesis that there are significant relationships between wheelchair skills scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. Materials and methods: We studied 26 participants, recording Wheelchair Skills Test Questionnaire scores and peak power output from graded aerobic wheelchair exercise testing on a motorized treadmill. Results: The median Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores were 83.3%, 81.5%, and 76.7% and the median peak power output was 58.2 W. On regression analysis, there were significant relationships between the total Wheelchair Skills Test Questionnaire capacity, confidence, and performance scores and peak power output (R2 0.270–0.709, odds ratios 1.043–1.150, p < 0.05). Conclusions: Significant relationships exist between the wheelchair skills capacity, confidence, and performance scores and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. These findings suggest that both wheelchair skills training and exercise training may be useful during the rehabilitation of people with spinal cord injury. Moderate positive relationships exist between wheelchair skills capacity and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. Moderate positive relationships exist between wheelchair skills confidence and the peak exercise capacity of community-dwelling manual wheelchair users with spinal cord injury. Although further research is needed, these findings suggest that clinicians should address both wheelchair skills training and exercise training during the rehabilitation of people with spinal cord injury and not assume that either alone is sufficient. [ABSTRACT FROM AUTHOR]

Controlling microbubble-mediated drug delivery requires the underlying biological and physical mechanisms to be unraveled. To image both microbubble oscillation upon ultrasound insonification and the resulting cellular response, we developed an optical imaging system that can achieve the necessary nanosecond temporal and nanometer spatial resolutions. We coupled the Brandaris 128 ultra-high-speed camera (up to 25 million frames per second) to a custom-built Nikon A1R+ confocal microscope. The unique capabilities of this combined system are demonstrated with three experiments showing microbubble oscillation leading to either endothelial drug delivery, bacterial biofilm disruption, or structural changes in the microbubble coating. In conclusion, using this state-of-the-art optical imaging system, microbubble-mediated drug delivery can be studied with high temporal resolution to resolve microbubble oscillation and high spatial resolution and detector sensitivity to discern cellular response. Combining these two imaging technologies will substantially advance our knowledge on microbubble behavior and its role in drug delivery. [ABSTRACT FROM AUTHOR]

Purpose: The tilt-rest skill consists of tipping the wheelchair back and allowing it to rest against a solid object with the wheel locks applied (e.g., for pressure redistribution, neck comfort or hands-free activities). The objective of this study was to determine the proportion of experienced manual wheelchair users who are aware of this skill and who can perform it. Materials and methods: We conducted a cross-sectional survey of 49 manual wheelchair users using a questionnaire developed for the purpose. The tilt-rest skill was attempted by those who reported that they were capable of performing it. Results: Participants' mean (SD) age was 55.1 (18.2) years, 38 (77.6%) were male, their median (IQR) duration of wheelchair use was 2 (7.2) years and their mean (SD) daily time spent in the wheelchair was 9.5 (4.6) hours. Twenty-seven (55.1%) participants were aware of the skill, 19 (38.8%) reported being able to perform the skill and 16 of 47 (34.0%) were able to demonstrate the skill. Multivariate modelling with the question "Can you complete the tilt-rest skill?" as the dependent measure revealed an inverse relationship with age – Odds Ratio (95% Confidence Interval) of 0.476 (0.293, 0.774) (p =.0028) for each 10 year increase in age. Conclusions: Only just over half of manual wheelchair users are aware of the tilt-rest skill and one-third of users can perform it. Older people are less likely to report being able to complete the skill. These findings have implications for wheelchair skills training during the wheelchair-provision process. Only just over half of manual wheelchair users are aware of the tilt-rest skill and only about one-third of users can perform it. Older people are less likely to report being able to complete the skill. These findings have clinical implications for wheelchair skills training during the, specifically that clinicians responsible for manual wheelchair-provision process should ensure that appropriate wheelchair users have the opportunity to learn this skill. [ABSTRACT FROM AUTHOR]

We sought to identify opportunities, challenges, contemporary initiatives and strategies for preparing entry-level practitioners who are competent at the basic level of wheelchair service provision across four key international professional rehabilitation organisations as revealed by their educational standards, relevant guidelines and policy statements, and other publicly available information. A rapid review was conducted in 2021 from the International Society of Physical and Rehabilitation Medicine (ISPRM), the International Society for Prosthetics and Orthotics (ISPO), World Physiotherapy, and the World Federation of Occupational Therapists (WFOT). Additional grey-literature and grey-data searches were conducted to identify contemporary initiatives that may support competency development in wheelchair service provision. A total of 17 standards, guidelines, and policy statement documents were selected for detailed review. Each of the four organisations published at least one document containing language relating to wheelchair service provision. Twelve contemporary initiatives relating to wheelchair service provision were identified from the grey literature across the four organisations. Six additional initiatives were identified from the organisations' social media accounts. Themes emerged in the areas of contemporary content, opportunities, and challenges. Global standardisation could help harmonise professional societies' approach to training wheelchair service providers. There is a need to provide more descriptive content on wheelchair service provision in education and service standards and related documents to influence what is taught in professional rehabilitation programs that are accredited or approved by professional rehabilitation organisations. The organisations' networks are vast and may also help to promote additional continuing education in this area. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP). Data Sources: We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017. Study Selection: Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP. Data Extraction: Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane's Risk of Bias Tool. Data Synthesis: Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p <.0001) compared to no treatment, standard care or educational controls, a relative increase over baseline of 21.2%. Subgroup analyses showed that training was more effective for new wheelchair users. Retention of training effects was suggested by the absence of significant declines between tests post-training and at follow-up. The WSTP was found to have positive effects on some other outcomes. No serious adverse events were reported. Conclusions: There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes. A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline. Subgroup analyses showed that training was more effective for new wheelchair users. The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported. The WSTP warrants cautious implementation in clinical and educational settings. [ABSTRACT FROM AUTHOR]

Reports on the surface properties of Cr[sub2]O[sub3]. Common problem in high-power klystron tube manufacture; X-ray diffraction analysis of Cr[sub2]O[sub3]; Measurement of the yield of Cr[sub2]O[sub3].

Remodeling of the extracellular matrix in human ovarian cancer can be manifested in increased collagen concentration, changes in alignment within fibrils/fibers and/or up-regulation of different collagen isoforms. We used pixel-based second harmonic generation (SHG) polarization microscopy analyses to probe these molecular changes in human ovarian tissues [normal stroma, benign tumors, and high-grade serous (HGS) tumors] by: (i) determination of the α-helical pitch angle via the single-axis molecular model, (ii) collagen alignment within fibrils via SHG anisotropy, and (iii) chirality via SHG circular dichroism (SHG-CD). Pixel approaches are required due to the complex structure of the matrix that lacks a high degree of fiber alignment. The largest differences in the helical pitch angle were between normal stroma and benign tumors, consistent with gene expression showing the Col III isoform is up-regulated in the latter. The data were not consistent with up-regulation of Col III in HGS tumors as previous reports have suggested. The different tissues also displayed differing SHG anisotropies and SHG-CD responses, consistent with either Col III incorporation or randomization of Col I alignment within benign and malignant tumors. Additionally, the high-grade tumors displayed higher collagen concentration, where this desmoplasia is consistent with the higher fiber density in these tissues. These results collectively indicate that the fibril assemblies are distinct in all tissues, where these differences likely result from the synthesis of collagen rather than remodeling of existing collagen. Importantly, these analyses are label-free and interrogate subresolution collagen structure on intact tissues, without the need for conventional structural biology tools. [ABSTRACT FROM AUTHOR]

The collagen architecture in all human ovarian cancers is substantially remodeled, where these alterations are manifested in different fiber widths, fiber patterns, and fibril size and packing. Second harmonic generation (SHG) microscopy has differentiated normal tissues from high-grade serous (HGS) tumors with high accuracy; however, the classification between low-grade serous, endometrioid, and benign tumors was less successful. We postulate this is due to known higher genetic variation in these tissues relative to HGS tumors, which are genetically similar, and this results in more heterogeneous collagen remodeling in the respective matrix. Here, we examine fiber widths and SHG emission intensity and directionality locally within images (e.g., 10 × 10 microns) and show that normal tissues and HGS tumors are more uniform in fiber properties as well as in fibril size and packing than the other tissues. Moreover, these distributions are in good agreement with phase matching considerations relating SHG emission directionality and intensity. The findings show that in addition to average collagen assembly properties the intrinsic heterogeneity must also be considered as another aspect of characterization. These local analyses showed differences not shown in pure intensity-based image analyses and may provide further insight into disease etiology of the different tumor subtypes. [ABSTRACT FROM AUTHOR]

The irreversible response of magnetic materials to magnetic fields of arbitrary time dependence is investigated by a master-equation approach. The magnetization reversal is expressed in terms of renormalized magnetization modes, and the resulting set of two-level master equations is solved by direct integration. The theory applies not only to linear energy-barrier laws but also to the physically more reasonable case where the activation energy is a nonlinear function of the applied field. Particular emphasis is on the relation between sweep-rate and magnetic-viscosity dynamics. Other regimes, such as oscillating magnetic fields, can be mapped onto sweep-rate dynamics. Magnetic-viscosity and sweep-rate experiments reflect the same fundamental magnetization processes, but energy barriers probed by dynamic experiments are smaller by about 20%. [ABSTRACT FROM AUTHOR]

Presents information on a study which investigated the influence of the shape of the energy landscape on the magnetic viscosity. Quantum-statistical background of magnetic viscosity; Magnetic interpretation of Kramer's escape-rate theory of chemical reaction kinetics in an activation-entropy approach; Conclusions.

Extensive remodeling of the extracellular matrix (ECM) occurs in many epithelial cancers. For example, in ovarian cancer, upregulation of collagen isoform type III has been linked to invasive forms of the disease, and this change may be a potential biomarker. To examine this possibility, we implemented wavelength-dependent second harmonic generation circular dichroism (SHG-CD) imaging microscopy to quantitatively determine changes in chirality in ECM models comprised of different Col I/Col III composition. In these models, Col III was varied between 0 and 40%, and we found increasing Col III results in reduced net chirality, consistent with structural biology studies of Col I and III in tissues where the isoforms comingle in the same fibrils. We further examined the wavelength dependence of the SHG-CD to both optimize the response and gain insight into the underlying mechanism. We found using shorter SHG excitation wavelengths resulted in increased SHG-CD sensitivity, where this is consistent with the electric-dipole-coupled oscillator model suggested previously for the nonlinear chirality response from thin films. Moreover, the sensitivity is further consistent with the wavelength dependency of SHG intensity fit to a two-state model of the two-photon absorption in collagen. We also provide experimental calibration protocols to implement the SHG-CD modality on a laser scanning microscope. We last suggest that the technique has broad applicability in probing a wide range of diseased states with changes in collagen molecular structure. [ABSTRACT FROM AUTHOR]

Background: Ovarian cancer remains the most deadly gynecological cancer with a poor aggregate survival rate; however, the specific rates are highly dependent on the stage of the disease upon diagnosis. Current screening and imaging tools are insufficient to detect early lesions and are not capable of differentiating the subtypes of ovarian cancer that may benefit from specific treatments.Method: As an alternative to current screening and imaging tools, we utilized wavelength dependent collagen-specific Second Harmonic Generation (SHG) imaging microscopy and optical scattering measurements to probe the structural differences in the extracellular matrix (ECM) of normal stroma, benign tumors, endometrioid tumors, and low and high-grade serous tumors.Results: The SHG signatures of the emission directionality and conversion efficiency as well as the optical scattering are related to the organization of collagen on the sub-micron size scale and encode structural information. The wavelength dependence of these readouts adds additional characterization of the size and distribution of collagen fibrils/fibers relative to the interrogating wavelengths. We found a strong wavelength dependence of these metrics that are related to significant structural differences in the collagen organization and are consistent with the dualistic classification of type I and II serous tumors. Moreover, type I endometrioid tumors have strongly differing ECM architecture than the serous malignancies. The SHG metrics and optical scattering measurements were used to form a linear discriminant model to classify the tissues, and we obtained high accuracy (>90%) between high-grade serous tumors from the other tissue types. High-grade serous tumors account for ~70% of ovarian cancers, and this delineation has potential clinical applications in terms of supplementing histological analysis, understanding the etiology, as well as development of an in vivo screening tool.Conclusions: SHG and optical scattering measurements provide sub-resolution information and when combined provide superior diagnostic power over clinical imaging modalities. Additionally the measurements are able to delineate the different subtypes of ovarian cancer and may potentially assist in treatment protocols. Understanding the altered collagen assembly can supplement histological analysis and provide new insight into the etiology. These methods could become an in vivo screening tool for earlier detection which is important since ovarian malignancies can metastasize while undetectable by current clinical imaging resolution. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. Methods: We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30–45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. Results: Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021). Conclusions: Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation. [ABSTRACT FROM AUTHOR]

Cardiac safety assays incorporating label-free detection of human stem-cell derived cardiomyocyte contractility provide human relevance and medium throughput screening to assess compound-induced cardiotoxicity. In an effort to provide quantitative analysis of the large kinetic datasets resulting from these real-time studies, we applied bioinformatic approaches based on nonlinear dynamical system analysis, including limit cycle analysis and autocorrelation function, to systematically assess beat irregularity. The algorithms were integrated into a software program to seamlessly generate results for 96-well impedance-based data. Our approach was validated by analyzing dose- and time-dependent changes in beat patterns induced by known proarrhythmic compounds and screening a cardiotoxicity library to rank order compounds based on their proarrhythmic potential. We demonstrate a strong correlation for dose-dependent beat irregularity monitored by electrical impedance and quantified by autocorrelation analysis to traditional manual patch clamp potency values for hERG blockers. In addition, our platform identifies non-hERG blockers known to cause clinical arrhythmia. Our method provides a novel suite of medium-throughput quantitative tools for assessing compound effects on cardiac contractility and predicting compounds with potential proarrhythmia and may be applied to in vitro paradigms for pre-clinical cardiac safety evaluation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the test–retest reliability, concurrent validity and responsiveness of the Wheelchair Skills Test – Questionnaire (WST-Q) Version 4.1 for powered wheelchair users.Methods: A volunteer sample of 72 community-dwelling, experienced powered wheelchair users, ranging in age from 50 to 77 years, participated in this study. Participants completed measures at baseline and 1 month later.Results: Mean ± standard deviation total percentage WST-Q scores at baseline and 1 month were 83.7% ± 10.9 and 86.3% ± 10.0 respectively. Cronbach’s alpha was 0.90 and the 1 month test–retest intraclass correlation coefficient (ICC1,1) was 0.78 (confidence interval: 0.68–0.86). There were no floor or ceiling effects. Percentages of agreement between baseline and 1 month for individual skills ranged from 72.2% to 100%. The correlations between the WST-Q and the objective Wheelchair Skills Test (WST), WheelCon and Life Space Assessment werer = 0.65,r = 0.47 andr = 0.47 respectively. The standard error of measurement (SEM) and smallest real difference (SRD) were 5.0 and 6.2 respectively.Conclusion: The WST-Q 4.1 has high internal consistency, strong test–retest reliability and strong support for concurrent validity and responsiveness.Implications for Rehabilitation:There is evidence of reliability, validity and responsiveness of the Wheelchair Skills Test – Questionnaire (WST-Q) among experienced older adult powered wheelchair users.The WST-Q can be used to measure powered wheelchair skills, guide intervention and measure change over time. [ABSTRACT FROM PUBLISHER]

Presents a study which tested the electronic structure of iron (100) surface by absorbed current spectroscopy. Decrease of absorbed current at high electron energy; Experimental results; Discussion.

Studies the magnetization reversal of cobalt/chromium multilayer films by utilizing initial magnetization curves, minor loops, isothermal and direct current demagnetization remanence curves and temperature dependence of the loops. Measurement of the magnetic interactions among the grains; Film preparation and measurements; Comparison with the Stoner-Wohlfarth model for rotation mechanism.

Examines the magnetization reversal and defects in cobalt/platinum multilayers. Uniform domain expansion; Distribution of activation energies; Magnetization reversal process.

Presents a study that produced manganese (Mn)-bismuth (Bi)-aluminum thin films by sequential evaporation of the constituents. Temperature dependencies of the Kerr rotation angle; Composition dependencies of the absolute reflectivity; Factor that will make thin films retain the pure MnBi hexagonal structure.

The present state of navigation engineering knowledge concerning nautical depth in ports and waterways with fluid mud is summarized to examine the potential for successful application of the nautical depth concept in U.S. navigable waterways. Nautical depth defines a safe and effective channel bottom criterion in areas where fluid mud confounds conventional acoustic (echo sounder) surveying methods. Fluid mud is a high-concentration suspension that typically behaves as a non-Newtonian fluid. It occurs in ports and channels on all U. S. coastlines and accounts for a significant portion of the United States' $1 billion dredging expense. Nautical depth has been adopted in multiple ports on three continents. Where nautical depth application is appropriate, it often reduces dredging frequency and dredged material volume and can provide water quality benefits. Multiple experiments and field experience have shown that vessels can safely transit areas with fluid mud below the keel. The United States' adoption of the nautical depth concept for select ports and waterways can be expected to reduce dredging frequency and volumes. It offers potential economic and environmental benefits but will require a consensus among federal, state, and local organizations with responsibilities for constructing, operating, maintaining, marking, and using navigable waterways. [ABSTRACT FROM AUTHOR]

Underwater stereo-video photogrammetry was used to document the pectoral fin positions of various lifehistory stages of the critically endangered east Australian population of the grey nurse shark (Carcharias taurus) during normal swimming behaviour at multiple aggregation sites. A wide range in pectoral fin positions was recorded with dihedral pectoral fin angles ranging from -25 to 88°. Pectoral fin angles varied significantly among sites and this was attributed to the differing navigational and energetic requirements of the sharks. There was no significant relationship between pectoral fin angles and distances separating the shark and scuba diver. The wide range in pectoral fin angles, interactive use of the fins during swimming, low-energy behaviours of the sharks at aggregation sites and absence of 'fight' response agonistic behaviour indicated that the species does not exhibit agonistic pectoral fin depression. Reports of agonistic pectoral fin depression in the grey nurse shark obtained with visual estimates should be treated as preliminary observations requiring further testing using accurate sampling methods such as stereo photogrammetry. It is important that diver compliance with existing management guidelines that prohibit divers from chasing or harassing grey nurse sharks and blocking cave and gutter entrances is maintained. [ABSTRACT FROM AUTHOR]

Purpose: The collagen structure throughout the patella has not been thoroughly investigated by 3D imaging, where the majority of the existing data come from histological cross sections. It is important to have a better understanding of the architecture in normal tissues, where this could then be applied to imaging of diseased states. Methods: To address this shortcoming, we investigated the combined use of collagen-specific Second-Harmonic Generation (SHG) imaging and measurement of bulk optical properties to characterize collagen fiber orientations of the histologically defined zones of bovine articular cartilage. Forward and backward SHG intensities of sections from superficial, middle and deep zones were collected as a function of depth and analyzed by Monte Carlo simulations to extract the SHG creation direction, which is related to the fibrillar assembly. Results: Our results revealed differences in SHG forward-backward response between the three zones, where these are consistent with a previously developed model of SHG emission. Some of the findings are consistent with that from other modalities; however, SHG analysis showed the middle zone had the most organized fibril assembly. While not distinct, we also report bulk optical property values for these different zones within the patella. Conclusions: Collectively, these results provide quantitative measurements of structural changes at both the fiber and fibril assembly of the different cartilage zones and reveals structural information not possible by other microscope modalities. This can provide quantitative insight to the collagen fiber network in normal cartilage, which may ultimately be developed as a biomarker for osteoarthritis. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to test the hypothesis that people with stroke who receive formal powered wheelchair skills training improve their wheelchair skills to a significantly greater extent than participants in a control group who do not and to explore the influence of spatial neglect. Design: Seventeen participants with stroke (including nine with spatial neglect) were randomly allocated to intervention (n = 9) or control (n = 8) groups. Those in the intervention group received up to five 30-min training sessions based on the Wheelchair Skills Training Program 4.1. The powered Wheelchair Skills Test version 4.1 was administered at baseline (T1) and after training (T2). Results: A rank order analysis of covariance on the T2 Wheelchair Skills Test score, having adjusted for the T1 score, showed a significant effect caused by group (P = 0.0001). A secondary analysis showed no significant effect caused by spatial neglect (P = 0.923). Conclusions: People with stroke who receive formal powered wheelchair skills training improve their powered wheelchair skills to a significantly greater extent (30%) than participants who do not (0%). The extent of change was not affected by the presence of spatial neglect. These findings have significance for the wheelchair provision process and the rehabilitation of people with stroke. [ABSTRACT FROM AUTHOR]

[Display omitted] Bacterial biofilms are a huge burden on our healthcare systems worldwide. The lack of specificity in diagnostic and treatment possibilities result in difficult-to-treat and persistent infections. The aim of this in vitro study was to investigate if microbubbles targeted specifically to bacteria in biofilms could be used both for diagnosis as well for sonobactericide treatment and demonstrate their theranostic potential for biofilm infection management. The antibiotic vancomycin was chemically coupled to the lipid shell of microbubbles and validated using mass spectrometry and high-axial resolution 4Pi confocal microscopy. Theranostic proof-of-principle was investigated by demonstrating the specific binding of vancomycin-decorated microbubbles (vMB) to statically and flow grown Staphylococcus aureus (S. aureus) biofilms under increasing shear stress flow conditions (0–12 dyn/cm2), as well as confirmation of microbubble oscillation and biofilm disruption upon ultrasound exposure (2 MHz, 250 kPa, and 5,000 or 10,000 cycles) during flow shear stress of 5 dyn/cm2 using time-lapse confocal microscopy combined with the Brandaris 128 ultra-high-speed camera. Vancomycin was successfully incorporated into the microbubble lipid shell. vMB bound significantly more often than control microbubbles to biofilms, also in the presence of free vancomycin (up to 1000 µg/mL) and remained bound under increasing shear stress flow conditions (up to 12 dyn/cm2). Upon ultrasound insonification biofilm area was reduced of up to 28%, as confirmed by confocal microscopy. Our results confirm the successful production of vMB and support their potential as a new theranostic tool for S. aureus biofilm infections by allowing for specific bacterial detection and biofilm disruption. [ABSTRACT FROM AUTHOR]

Introduction. Whilst most consequences of diabetes mellitus are well recognized, breast-related complications remain obscure. The term diabetic mastopathy (DMP) attempts to describe the breast-related consequences of diabetes. Methods. We report the clinicopathologic findings in a patient with DMP and review the literature on this uncommon entity. Results. A 33-year-old woman with type 1 diabetes had excision biopsy of a 2 cm breast lump. Histopathologic evaluation revealed classic features of DMP: parenchymal fibrosis; keloid-like hyalinization of interlobular stroma; adipose tissue entrapment; lobular compression; dense chronic inflammatory cell infiltration; and lymphoid follicle formation. Conclusion. Clinicians should be aware of DMP as a differential for breast disease in women with uncontrolled diabetes. [ABSTRACT FROM AUTHOR]

Background: The gold standard for investigating the cause of renal graft dysfunction is renal biopsy. How-ever, as this procedure is invasive and has inherent risks, its safety must be established. Objective: To determine the safety of percutaneous renal biopsy in pediatric orthotopic renal transplantation. Methods: Percutaneous renal biopsies performed on pediatric orthotopic renal transplants in a single center between 1987 and 2010 were studied. Biopsy specimen adequacy and post-procedure complications were reviewed by prospectively collected data. Results: A total of 54 ultrasound "real-time" guided biopsies in 25 patients were performed. Minimum specimen adequacy was achieved in 98% of biopsy specimens. No major complications were identified; 6% of patients developed minor complications--e.g., grade 3 macroscopic hematuria that did not require intervention. Conclusion: Percutaneous renal biopsies using "real-time" ultrasound guidance on pediatric orthotopic kid-ney transplants is safe. [ABSTRACT FROM AUTHOR]

Enhanced recovery after surgery (ERAS) programs can accelerate recovery and shorten the hospital stay after colorectal resections. The RAPID (remove, ambulate, postoperative analgesia, introduce diet) protocol is a simplified ERAS program that consists of a simplified, user-friendly single-page pro forma schedule. This study aimed to evaluate the impact of the RAPID protocol on patients undergoing both laparoscopic and open colorectal resections in two specialized colorectal units. A prospective, two-center study assessed 117 age-matched patients undergoing open or laparoscopic colorectal resection to compare the postoperative course for patients using the RAPID protocol with those treated in a traditional manner. Of the 117 patients studied, 70 underwent laparoscopic resection (55 with the RAPID protocol) and 47 underwent open resection (25 with the RAPID protocol). Patients undergoing laparoscopic resections with the RAPID protocol had a significantly shorter hospital stay ( p = 0.01) and tolerance of a full diet ( p = 0.002). Similarly, patients undergoing open resections with the RAPID protocol also have a significantly shorter hospital stay ( p = 0.04). The RAPID protocol is a user-friendly, easy, and effective tool that facilitates earlier tolerance of diet and discharge from the hospital for patients undergoing laparoscopic or open colorectal resections. [ABSTRACT FROM AUTHOR]

Improved detection techniques, robotically assisted surgery and more effective treatment are beginning to offer real benefits to men with prostate cancer. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the level of awareness of prostate cancer (PCa) among the general public and PCa patients in Europe and North America. A survey was undertaken across four European countries (UK, Germany, Italy and Spain), and across the United States and Canada in late 2007. In total, 1008 men with PCa and their partners (the ‘prostate sample’), and 911 men without PCa and their partners (the ‘well sample’) participated in the survey, all aged 50 years. Interviews were conducted through telephone, pen and paper, and online. Many people surveyed (53%) thought that breast cancer is more common than PCa. Moreover, 1 in 10 people from the well sample (10%) thought that PCa affects both men and women. When the prostate sample was asked about their perceived level of risk of PCa before diagnosis, 50% believed that they/their husband or partner were previously at low or very low risk, before they were diagnosed. Awareness of the major risk factors for PCa (age and family history) was generally good, but respondents were less clear about the role of other potential factors, such as smoking and drinking alcohol. This international survey, thought to be largest of its type, shows that although patient and public awareness of PCa is generally satisfactory, there is still a considerable lack of clarity about PCa risk factors, and a danger for people to underestimate their own/their partner's perceived risk for PCa. Programmes to responsibly educate and inform men and their partners about risk factors, prevalence and screening tools for PCa are required. [ABSTRACT FROM AUTHOR]

Abstract: Identifying an appropriate method for modelling automotive dissipative silencers normally requires one to choose between analytic and numerical methods. It is common in the literature to justify the choice of an analytic method based on the assumption that equivalent numerical techniques are more computationally expensive. The validity of this assumption is investigated here, and the relative speed and accuracy of two analytic methods are compared to two numerical methods for a uniform dissipative silencer that contains a bulk reacting porous material separated from a mean gas flow by a perforated pipe. The numerical methods are developed here with a view to speeding up transmission loss computation, and are based on a mode matching scheme and a hybrid finite element method. The results presented demonstrate excellent agreement between the analytic and numerical models provided a sufficient number of propagating acoustic modes are retained. However, the numerical mode matching method is shown to be the fastest method, significantly outperforming an equivalent analytic technique. Moreover, the hybrid finite element method is demonstrated to be as fast as the analytic technique. Accordingly, both numerical techniques deliver fast and accurate predictions and are capable of outperforming equivalent analytic methods for automotive dissipative silencers. [Copyright &y& Elsevier]

This paper examines the similarities and contrasts between environmental and water quality changes caused by the 1966 tidal power barrage at La Rance in North Brittany, France and those expected to result from construction of a tidal power barrage in the Severn estuary in the UK. Over the 40-year period since the opening of La Rance, a great deal of knowledge has been accumulated concerning the operation of such schemes and the way water quality and ecosystems have altered. Knowledge gained from experiences at Rance is consequently of great benefit in predicting the effects of the proposed Severn barrage. The nature of the changes anticipated in the Severn estuary is thus unambiguous, but whether this would make the estuary better or worse is a matter of perception. As at Rance, it would be different. [ABSTRACT FROM AUTHOR]

Branching morphogenesis of the metanephric kidney is critically dependent on the delicate orchestration of diverse cellular processes including proliferation, apoptosis, migration, and differentiation. Sphingosine-1-phosphate (SIP) is a potent lipid mediator influencing many of these cellular events. We report increased expression and activity of both sphingosine kinases and SIP phosphatases during development of the mouse metanephric kidney from induction at embryonic day 11.5 to maturity. Sphingosine kinase activity exceeded SIP phosphatase activity in embryonic kidneys, resulting in a net accumulation of SIP, while kinase and phosphatase activities were similar in adult tissue, resulting in reduced SIP content. Sphingosine kinase expression was greater in the metanephric mesenchyme than in the ureteric bud, while the SiP phosphatase SPP2 was expressed at greater levels in the ureteric bud. Treatment of cultured embryonic kidneys with sphingosine kinase inhibitors resulted in a dose-dependent reduction of ureteric bud tip numbers and increased apoptosis. Exogenous SIP rescued kidneys from apoptosis induced by kinase inhibitors. Ureteric bud tip number was unaffected by exogenous SIP in kidneys treated with N,N-dimethyisphingosine, although tip number increased in those treated with D,L-threo-dihydrosphingosine. SIP1 and SIP2 were the predominant SIP receptors expressed in the embryonic kidney. SIP1 expression increased during renal development while expression of SIP2 decreased, and both receptors were expressed predominantly in the metanephric mesenchyme. These results demonstrate dynamic regulation of SIP homeostasis during renal morphogenesis and suggest that differential expression of SIP metabolic enzymes and receptors provides a novel mechanism contributing to the regulation of kidney development. [ABSTRACT FROM AUTHOR]

The article discusses the study which aims to test the hypothesis that larger and more expensive manual tilt-in-space wheelchair, a lightweight manual wheelchair equipped with new rear antitip devices provides comparable mean sitting pressure in the tilted position. Respondents of the study were required to seat for 8 minutes in each wheelchair, upright and tilted back with the new rear antitip device wheelchair. In addition, the lightweight manual wheelchair is equipped with a rear antitip device which provides equivalent reductions of sitting pressures in the tilted position to a comparably tilted tilt-in-space wheelchair.

The article discusses the study which aims to examine the effect of a high-rolling-resistance training method on the success rate and time required to learn the wheelchair wheelie skill. It also intends to evaluate the effects of other factors on training time and to acquire data on the views of the subjects. Results show that success rates for those in the conventional and high-rolling-resistance training groups are 96 percent and 100 percent, respectively. Furthermore, training time is not affected by trainer or age, but by sex, and views of subjects in both groups on the training are positive.