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Background: Low back pain is prevalent and a leading cause of disability. We aimed to determine the clinical and cost-effectiveness of an accessible, scalable internet intervention for supporting behavioural self-management (SupportBack)., Methods: Participants in UK primary care with low back pain without serious spinal pathology were randomly assigned 1:1:1 using computer algorithms stratified by disability level and telephone-support centre to usual care, usual care and SupportBack, or usual care and SupportBack with physiotherapist telephone-support (three brief calls). The primary outcome was low back pain-related disability (Roland Morris Disability Questionnaire [RMDQ] score) at 6 weeks, 3 months, 6 months, and 12 months using a repeated measures model, analysed by intention to treat using 97·5% CIs. A parallel economic evaluation from a health services perspective was used to estimate cost-effectiveness. People with lived experience of low back pain were involved in this trial from the outset. This completed trial was registered with ISRCTN, ISRCTN14736486., Findings: Between Nov 29, 2018, and Jan 12, 2021, 825 participants were randomly assigned (274 to usual care, 275 to SupportBack only, 276 to SupportBack with telephone-support). Participants had a mean age of 54 (SD 15), 479 (58%) of 821 were women and 342 (42%) were men, and 591 (92%) of 641 were White. Follow-up rates were 687 (83%) at 6 weeks, 598 (73%) at 3 months, 589 (72%) at 6 months, and 652 (79%) at 12 months. For the primary analysis, 736 participants were analysed (249 usual care, 245 SupportBack, and 242 SupportBack with telephone support). At a significance level of 0·025, there was no difference in RMDQ over 12 months with SupportBack versus usual care (adjusted mean difference -0·5 [97·5% CI -1·2 to 0·2]; p=0·085) or SupportBack with telephone-support versus usual care (-0·6 [-1·2 to 0·1]; p=0·048). There were no treatment-related serious adverse events. The economic evaluation showed that the SupportBack group dominated usual care, being both more effective and less costly. Both interventions were likely to be cost-effective at a threshold of £20 000 per quality adjusted life year compared with usual care., Interpretation: The SupportBack internet interventions did not significantly reduce low back pain-related disability over 12 months compared with usual care. They were likely to be cost-effective and safe. Clinical effectiveness, cost-effectiveness, and safety should be considered together when determining whether to apply these interventions in clinical practice., Funding: National Institute for Health and Care Research Health Technology Assessment (16/111/78)., Competing Interests: Declaration of interests LCR reports an educational grant from Pfizer held by their institute; consulting fees from the Musculoskeletal Association of Chartered Physiotherapists; and meeting support from Eurospine. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Optical communications (OC) through water bodies is an attractive technology for a variety of applications. Thanks to current single-photon detection capabilities, OC receiver systems can reliably decode very weak transmitted signals. This is the regime where pulse position modulation is an ideal scheme. However, there has to be at least one photon that goes through the pupil of the fore optics and lands in the assigned time bin. We estimate the detectable photon budget as a function of range for propagation through ocean water, both open and coastal. We make realistic assumptions about the water's inherent optical properties, specifically, absorption and scattering coefficients, as well as the strong directionality of the scattering phase function for typical hydrosol populations. We adopt an analytical (hence very fast) path-integral small-angle solution of the radiative transfer equation for multiple forward-peaked scattering across intermediate to large optical distances. Integrals are performed both along the directly transmitted beam (whether or not it is still populated) and radially away from it. We use this modeling framework to estimate transmission of a 1 J pulse of 532 nm light through open ocean and coastal waters. Thresholds for single-photon detection per time bin are a few km and a few 100 m. These are indicative estimates that will be reduced in practice due to sensor noise, background light, turbulence, bubbles, and so on, to be included in future work.

In 2023, South Africa continued to experience sporadic cases of clade 2.3.4.4b H5N1 high-pathogenicity avian influenza (HPAI) in coastal seabirds and poultry. Active environmental surveillance determined that H5Nx, H7Nx, H9Nx, H11Nx, H6N2, and H12N2, amongst other unidentified subtypes, circulated in wild birds and ostriches in 2023, but that H5Nx was predominant. Genome sequencing and phylogenetic analysis of confirmed H5N1 HPAI cases determined that only two of the fifteen sub-genotypes that circulated in South Africa in 2021-2022 still persisted in 2023. Sub-genotype SA13 remained restricted to coastal seabirds, with accelerated mutations observed in the neuraminidase protein. SA15 caused the chicken outbreaks, but outbreaks in the Paardeberg and George areas, in the Western Cape province, and the Camperdown region of the KwaZulu-Natal province were unrelated to each other, implicating wild birds as the source. All SA15 viruses contained a truncation in the PB1-F2 gene, but in the Western Cape SA15 chicken viruses, PA-X was putatively expressed as a novel isoform with eight additional amino acids. South African clade 2.3.4.4b H5N1 viruses had comparatively fewer markers of virulence and pathogenicity compared to European strains, a possible reason why no spillover to mammals has occurred here yet.

Background: High-pathogenicity avian influenza (HPAI) has become a conservation threat to wild birds. Therefore, suitable vaccine technology and practical application methods require investigation., Methods: Twenty-four African penguins (Spheniscus demersus) were vaccinated with either a conventional inactivated clade 2.3.4.4b H5N8 HPAI whole virus or a tobacco leaf-produced H5 haemagglutinin-based virus-like particle (VLP). Six birds received a second dose of the inactivated vaccine. Antibody responses were assessed and compared by employing haemagglutination inhibition tests., Results: A second dose of inactivated vaccine was required to induce antibody titres above the level required to suppress virus shedding, while a single dose of VLP vaccine produced these levels by day 14, and one bird still had antibodies on day 430., Limitations: Bacterial contamination of the VLP vaccine limited the monitoring period and sample size in that treatment group, and it was not possible to perform a challenge study with field virus., Conclusion: VLP vaccines offer a more practical option than inactivated whole viruses, especially in logistically challenging situations involving wild birds., (© 2023 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

The Laser Communications Relay Demonstration is NASA's multi-year demonstration of laser communication from the Earth to a geosynchronous satellite. The mission currently has two optical ground stations (OGSs), with one in California (OGS1) and one in Hawaii (OGS2). Each ground terminal optical system consists of a high-order adaptive optics (AO) system, a laser transmit system, and a camera for target acquisition. The OGS1 AO system is responsible for compensating for the downlink beam for atmospheric turbulence and coupling it into the modem's single mode fiber. The mission requires a coupling efficiency of 50%, which necessitates a high-order AO system. To achieve this performance, the AO system uses two deformable mirrors with one mirror correcting for low-spatial-frequency aberrations with large amplitude and a second deformable mirror correcting for high-spatial-frequency aberrations with small amplitude. Turbulence is sensed with a Shack-Hartmann wavefront sensor. To meet its performance requirements in the most stressing conditions, the system can operate at frame rates of 20 kHz. This high frame rate is enabled by the design of the real-time control system. We present an overview of both the hardware and software design of the system, and describe the control system and methods of reducing non-common path aberrations. Finally, we show measured system performance.

Importance: Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact., Objective: To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors., Design, Setting, and Participants: Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores., Exposure: Moving to a low-poverty neighborhood., Main Outcomes: Caregiver-reported asthma exacerbations and symptoms., Results: Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations., Conclusions and Relevance: Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.

The known host range of circoviruses is continuously expanding because of more intensive diagnostic activities and advanced sequencing tools. Recently, a new circovirus (penguin circovirus (PenCV)) was identified in the guano and cloacal samples collected from Adélie penguins ( Pygoscelis adeliae ) and chinstrap penguins ( Pygoscelis antarcticus ) in Antarctica. Although the virus was detected in several asymptomatic subjects, a potential association with feather disease was speculated. To investigate the occurrence and implications of PenCV in other penguin species located outside of Antarctica, a broad survey was undertaken in African penguins ( Spheniscus demersus ) on two islands off the southern Namibian coast. For this purpose, specific molecular biology assays were developed and validated. None of the 151 blood samples tested positive for PenCV. Several reasons could explain the lack of PenCV positive samples. African penguins and Pygoscelis species are separated by approximately 6000 km, so there is almost no opportunity for transmission. Similarly, host susceptibility to PenCV might be penguin genus-specific. Overall, the present study found no evidence of PenCV in African penguin colonies in Namibia. Further dedicated studies are required to assess the relevance of PenCV among different penguin species.

From late 2017 to early 2018, clade 2.3.4.4B H5N8 highly pathogenic avian influenza (HPAI) viruses caused mass die-offs of thousands of coastal seabirds along the southern coastline of South Africa. Terns (Laridae) especially were affected, but high mortalities in critically endangered and threatened species like African Penguins (Spheniscus demersus) caused international concern and, exactly a year later, the disease recurred at a key African Penguin breeding site on Halifax Island, Namibia. Twenty-five clade 2.3.4.4B H5N8 HPAI viruses from coastal seabirds and a Jackal Buzzard (Buteo rufofuscus) were isolated and/or sequenced in this study. Phylogenetic analyses of the full viral genomes and time to the most recent common ancestor (tMRCA) analyses of the HA, NA, PB1 and PA genes determined that the South African coastal seabird viruses formed a monophyletic group nested within the South African genotype 4 viruses. This sub-lineage likely originated from a single introduction by terrestrial birds around October 2017. Only the HA and NA sequences were available for the Namibian penguin viruses, but the phylogenetic data confirmed that the South African coastal seabird viruses from 2017 to 2018 were the source and the most closely related South African virus was found in a gull. tMRCA analyses furthermore determined that the progenitors of the five genotypes implicated in the earlier 2017 South African outbreaks in wild birds and poultry were dated at between 2 and 4 months prior to the index cases. tMRCA and phylogenetic data also showed that the novel genotype 6 virus introduced to South Africa in 2018, and later also detected in Nigeria and Poland in 2019, most likely arose in late 2017 in West, Central or East Africa. We propose that it continued to circulate there, and that an unidentified reservoir was the source of both the South African outbreaks in early 2018 and in Nigeria in mid-2019., (© 2022 The Authors. Transboundary and Emerging Diseases published by Wiley-VCH GmbH.)

High pathogenicity avian influenza (HPAI) has become a major focus point worldwide due to its zoonotic potential and economic effects resulting from trade restrictions and high mortality rates in poultry. Key ostrich producing provinces of South Africa have experienced three H5N2 HPAI outbreaks (2004, 2006 and 2011) and one H5N8 HPAI (2017) outbreak over the past two decades. The Klein Karoo region in the Western Cape Province, a province with a largely Mediterranean climate, is the predominant ostrich producing region in the country. Understanding the epidemiology of HPAI in ostrich producing areas is an essential first step in developing effective and efficient control measures. This study investigated the spatiotemporal patterns associated with the 2011 (H5N2) and 2017 (H5N8) HPAI outbreaks in the key ostrich producing areas of South Africa. Six hundred and nine and 340 active ostrich farms/holdings were subjected to surveillance during 2011 and 2017 respectively, with over 70 % of these farms located within five local municipalities of the study area. Forty-two and fifty-one farms were affected in the 2011 and 2017 outbreaks respectively. Both HPAI outbreaks occurred predominantly in areas of high ostrich farm density. However, the temporal occurrence, spatial and directional distributions of the outbreaks were different. The 2011 outbreak occurred earlier in the South African autumn months with a predominantly contiguous and stationary distribution, whilst the 2017 outbreak onset was during the winter with a more expansive multidirectional spatial distribution. Results suggest potential dissimilarities in the important risk factors for introduction and possible mode of spread. The 2011 outbreak pattern resembled an outbreak characterised by point introductions with the risk of introduction possibly being linked to high ostrich farm density and common management and husbandry practices in the ostrich industry. In contrast, the 2017 outbreak appeared to have a more propagating mode of transmission. The findings highlight epidemiological features of HPAI outbreak occurrence within ostrich populations that could be used to inform surveillance and control measures including targeted surveillance within high-risk spatial clusters. The study emphasizes the importance of both; implementation of a multi-pronged approach to HPAI control and the need for constant evaluation of the interaction of the host, environment and agent with each outbreak, in order to strengthen disease control., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: There is an increasing affinity for remote health consultations (including telephone and virtual platforms), enabling new models of accessing services to evolve. Whilst many key skills are transferable from traditional to remote consultations, there is even greater emphasis on verbal communication skills during these interactions., Purpose: This masterclass considers the communication skills required for delivering remote health care consultations, in particular focussing on: 12 interactional features in an opening sequence of a remote call; active listening; how to offer advice using the Ask-Offer-Ask framework; and subtleties in phrasing and prosody when closing a call that may indicate a level of satisfaction (or otherwise)., Implications: In planning for digitally-enabled services to become mainstream, the differences in communication between remote and face-to-face consultations must be recognised and embraced., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Neighborhood greenness has been linked to better cardiovascular health, but little is known about its association with biomarkers related to cardiovascular risk. Adverse neighborhood conditions, such as disorder and socioeconomic disadvantage, are associated with higher cardiovascular biomarker levels, but these relationships may differ in neighborhoods with more greenness. This study evaluated cross-sectional associations of validated measures of neighborhood greenness, disorder, and socioeconomic disadvantage with cardiovascular biomarkers in middle-aged and older adults living in Baltimore City. The sample included 500 adults, aged 57-79 years, enrolled in the Baltimore Memory Study and living in Baltimore City during 2009-2010. Multi-level log-gamma regressions examined associations between the three neighborhood characteristics and seven cardiovascular biomarkers. Models additionally evaluated the effect modification by neighborhood greenness on associations of neighborhood disorder and socioeconomic disadvantage with the biomarkers. Adjusting for covariates and neighborhood greenness, greater neighborhood disorder was associated with higher C-reactive protein (exp β = 1.21, SE = 0.11, p = 0.035) and serum amyloid A (exp β = 1.28, SE = 0.12, p = 0.008), while greater neighborhood socioeconomic disadvantage was associated with higher tumor necrosis factor alpha (exp β = 1.24, SE = 0.12, p = 0.019). Higher neighborhood greenness was associated with lower soluble vascular cell adhesion molecule-1, accounting for disorder (exp β = 0.70, SE = 0.10, p = 0.010) and socioeconomic disadvantage (exp β = 0.73, SE = 0.10, p = 0.025). There was no evidence of effect modification among neighborhood characteristics. The findings suggest that neighborhood effects on cardiovascular health may be mediated through cardiovascular biomarker levels, and that socioeconomic disadvantage, disorder, and greenness may each be important features of neighborhoods.

Housing preferences and housing decision-making in later life are critical aspects of aging in place, which is a public health priority in many Western countries. However, few studies have examined the economic, social, and health factors that guide older adults' preferences and decisions about where to live, and even less so among older adults with low income or disabilities who may face greater barriers to aging in place. We sought to understand what housing decision-making and residential reasoning means for low-income older adult homeowners in Baltimore, Maryland. Using a grounded theory approach, we interviewed 12 adults with disabilities in June 2017 and February 2018. Our findings revealed how the strong desire to age in place turned into the realization that they had to age in place due to limited resources and options. The core category "shifting between wanting to age in place and having to age in place" was influenced by family needs, being a homeowner, the neighborhood, and coping at home. In conclusion, for low-income older adults with disabilities, it is important to acknowledge that sometimes aging in place may be equivalent to being stuck in place.

Objective: We explored patients' experiences of using Internet-based self-management support for low back pain (LBP) in primary care, with and without physiotherapist telephone guidance., Design: Exploratory descriptive qualitative study using thematic analysis, nested within a randomized feasibility trial., Methods: Patients with LBP who participated in a feasibility trial of the SupportBack Internet intervention (ISRCTN: 31034004) were invited to take part in semistructured telephone interviews after the three-month intervention period (a convenience sample from within the trial population). Fifteen participants took part (age range = 36-87 years, 66.7% female, characteristics representative of the trial population). Data were analyzed thematically., Results: Analysis resulted in the development of six themes (subthemes in parentheses): Perceptions of SupportBack's design (Clarity and ease of use, Variety and range of information provided, Need for specificity and flexibility), Engaging with the SupportBack intervention, Promoting positive thought processes (Reassurance, Awareness of self-management), Managing behavior with SupportBack (Motivation and goal setting, Using activity as a pain management strategy, Preferences for walking or gentle back exercises), Feeling supported by telephone physiotherapists (Provision of reassurances and clarity, Physiotherapists are motivating), Severity and comorbidity as barriers (Preexisting condition or severity acting as a barrier, Less useful for mild low back pain)., Conclusions: The Internet intervention SupportBack appeared to feasibly support self-management of LBP. Reassurance and ongoing support to implement behavioral changes were central to reported benefits. The addition of physiotherapist telephone support further enhanced the patient experience and the potential utility of the intervention., (© 2019 American Academy of Pain Medicine.)

In 2018, Cape Town, South Africa, nearly ran out of water. That this has not yet happened is in large part due to the water-saving efforts of its citizens. It is highly likely that this situation will be repeated in Cape Town and that similar situations will be experienced by major cities in other parts of the world. Efforts to save water should thus continue and the lessons learned in Cape Town should be shared. The functioning of Veterinary Services during a drought is affected in the same way as any business, in terms of running an office, but veterinary professionals face an increased risk of exposure to pathogens, compared to that of many occupations, and of veterinary officials becoming disease vectors. One component of Veterinary Services is veterinary laboratory services. Laboratory procedures rely heavily on water and, without advance planning, a laboratory's function can be severely limited by a restricted water supply. In many cases, innovative water-saving techniques can be used to reduce water use substantially without compromising the quality of the services offered. Here, the authors share their experiences and some lessons learned while working in Veterinary Services in the Western Cape province of South Africa.

Foot-and-mouth disease (FMD) prevention and control is a challenge worldwide but the situation in southern Africa is particularly complex because the virus is endemic in wild African buffalo (Syncerus caffer). The objective of this study was to compare stakeholder perceptions of the FMD control methods employed to restrict FMD virus to the infected zone of South Africa. Data collection was performed using an online questionnaire distributed to FMD experts, government veterinarians, private livestock veterinarians, people involved within the wildlife sector, and "other" occupation groups including the general public. Data were also collected using semi-structured participatory group discussions with government animal health technicians (AHT) and communal cattle owners directly affected by FMD control measures. Evaluated control methods were the disease control fence bordering the western boundary of the Greater Limpopo Transfrontier Conservation Area, clinical surveillance of livestock, movement control of cloven-hoofed animals and products, and routine FMD vaccination of cattle. These management procedures were scored according to a set of technical, economic, and ethical criteria by stakeholders, who also weighted the criteria according to their perceived importance. Scores and weights were aggregated using an additive linear model to rank control methods. Sensitivity analysis was performed using a stochastic model to explore the effects of varying inputs and the exclusion of scores from randomly selected respondent groups on the ranking of control methods. The deterministic analysis assigned the highest ranking to the disease control fence and the lowest to routine vaccination of cattle. The fence had the highest ranking in 40% of the stochastic iterations, and second, third and fourth in 26%, 20% and 14% of iterations, respectively. The inputs from the AHT and people involved in the wildlife sector were the most influential for ranking the fence as the preferred control option. The most influential criteria were the feasibility of the fence as a control option and its influence on the economics of the communal cattle owners, livestock industry in the FMD free zone, and the government. The disease control fence was the highest ranking control option but further investigations are necessary to understand the reasons for stakeholder perceptions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To determine the feasibility of a randomised controlled trial of an internet intervention for low back pain (LBP) using three arms: (1) usual care, (2) usual care plus an internet intervention or (3) usual care plus an internet intervention with additional physiotherapist telephone support., Design and Setting: A three-armed randomised controlled feasibility trial conducted in 12 general practices in England., Participants: Primary care patients aged over 18 years, with current LBP, access to the internet and without indicators of serious spinal pathology or systemic illness., Interventions: The 'SupportBack' internet intervention delivers a 6-week, tailored programme, focused on graded goal setting, self-monitoring and provision of tailored feedback to encourage physical activity. Additional physiotherapist telephone support consisted of three brief telephone calls over a 4-week period, to address any concerns and provide reassurance., Outcomes: The primary outcomes were the feasibility of the trial design including recruitment, adherence and retention at follow-up. Secondary descriptive and exploratory analyses were conducted on clinical outcomes including LBP-related disability at 3 months follow-up., Results: Primary outcomes: 87 patients with LBP were recruited (target 60-90) over 6 months, and there were 3 withdrawals. Adherence to the intervention was higher in the physiotherapist-supported arm, compared with the stand-alone internet intervention. Trial physiotherapists adhered to the support protocol. Overall follow-up rate on key clinical outcomes at 3 months follow-up was 84%., Conclusions: This study demonstrated the feasibility of a future definitive randomised controlled trial to determine the clinical and cost-effectiveness of the SupportBack intervention in primary care patients with LBP., Trial Registration Number: ISRCTN31034004; Results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Clinical guidelines recommend that investigations, such as magnetic resonance imaging, are offered only when likely to change management. Meanwhile, the optimal process of diagnosing radiculopathy remains uncertain and, in clinical practice, differences of opinion can occur between patient and clinician regarding the perceived importance of investigations., Objectives: To explore peoples' experiences of investigations and the effect of concordance between clinical presentation and investigation findings., Methods: In this qualitative study, 14 participants who had recently undergone investigations for a clinical presentation of radiculopathy were purposively recruited from an NHS, Primary Care Service in the United Kingdom. Based on the principles of interpretative phenomenological analysis, individual, semi-structured interviews were recorded and transcribed verbatim. Data were managed using a framework approach and analysed thematically., Findings: Although people reported wanting investigations to understand the cause of symptoms and inform management, access to them was reported to be difficult and protracted. When investigations revealed potentially relevant findings, people experienced relief, validation, empowerment and decisive decision-making. Disappointment emerged, however, regarding treatment options and waiting times, and long-term prognosis. When investigations failed to identify relevant findings, people were unable to make sense of their symptoms, relinquish their search to identify the cause, or to move forward in their management., Conclusions: This study provides the first reported in-depth interpretation of peoples' experience of undergoing investigations specifically for radiculopathy. Important implications have been identified for: investigation referral criteria; shared-decision-making; information sharing and managing expectations and disappointment. CLINICALTRIALS., Gov Reference: UOS-2307-CR., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aim of this study was to determine if selected kinematic measures (foot strike index [SI], knee contact angle and overstride angle) were different between aquatic treadmill (ATM) and land treadmill (LTM) running, and to determine if these measures were altered during LTM running as a result of 6 weeks of ATM training. Acute effects were tested using 15 competitive distance runners who completed 1 session of running on each treadmill type at 5 different running speeds. Subsequently, three recreational runners completed 6 weeks of ATM training following a single-subject baseline, intervention and withdrawal experiment. Kinematic measures were quantified from digitisation of video. Regardless of speed, SI values during ATM running (61.3 ± 17%) were significantly greater (P = 0.002) than LTM running (42.7 ± 23%). Training on the ATM did not change (pre/post) the SI (26 ± 3.2/27 ± 3.1), knee contact angle (165 ± 0.3/164 ± 0.8) or overstride angle (89 ± 0.4/89 ± 0.1) during LTM running. Although SI values were different between acute ATM and LTM running, 6 weeks of ATM training did not appear to alter LTM running kinematics as evidenced by no change in kinematic values from baseline to post intervention assessments.

Effective communication between healthcare professionals and their patients is crucial for successful consultations, and can profoundly affect patients' adherence to treatment. Despite this evidence, communication within the physiotherapy profession is still underexplored, in particular, how 'best' to open clinical encounters. This study explores the issue by seeking the preferences of physiotherapists for opening encounters in the adult musculoskeletal outpatient setting. Initially, 42 consultations and 17 first follow-up encounters were observed between qualified physiotherapists and patients with back pain. These encounters were audio-recorded, analysed and used to develop a questionnaire to determine clinicians' preferences for opening encounters. From these findings, a synopsis of the questionnaire was posted on the four most-relevant professional networks of the national, interactive Chartered Society of Physiotherapy (iCSP) website, to canvass opinion more widely. Among the 43 physiotherapists who responded, the preferred 'key clinical question' for an initial encounter was: "Do you want to just tell me a little bit about [your 'problem presentation'] first of all?"; and for follow-up encounters: 'How have you been since I last saw you?' These results provide an important and novel contribution to the profession, as debate on this issue has not previously been published. Although the sample size in this study is small, the aim of this paper is to generate reflection and debate among clinicians on their preferences for opening patient encounters and optimising the non-specific treatment effects., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Amid a political agenda for patient-centred healthcare, shared decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that shared decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of shared decision-making in clinical encounters involving physiotherapists and patients with back pain., Method: Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the shared decision-making competency of the clinicians., Results: The mean OPTION score was 24.0% (range 10.4-43.8%)., Conclusion: Shared decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to shared decision-making and further work should focus on when and how it can be implemented.

The liver fluke, Fasciola hepatica, is common in many parts of Great Britain. To detect liver fluke infection and to assess whether fasciolicide treatment has been successful, the faecal egg count (FEC) and faecal egg count reduction test (FECRT) are widely used. Rumen fluke is also increasingly reported from Great Britain, but its species identity is yet to be determined. Liver fluke and rumen fluke eggs are morphologically similar, which may lead to erroneous diagnoses of liver fluke infection or treatment failure. As an alternative to FEC, a coproantigen ELISA (cELISA) can be used. The potential for this test to cross-react with rumen fluke species from Great Britain has not been evaluated. Rumen fluke specimens from cattle and sheep in Scotland were identified to species level using DNA sequencing of the ITS-2 region. Subsequently, rumen and liver fluke obtained from naturally co-infected sheep were subjected to immunohistochemistry using antibodies from a commercially available cELISA kit for F. hepatica. Finally, faecal samples from naturally co-infected sheep flocks were examined by FEC and cELISA. Rumen fluke from imported and home-bred cattle and sheep in Scotland belonged to the species Calicophoron daubneyi, rather than Paramphistomum cervi, the species presumed to be most common in Great Britain. Intense staining of the gastrodermis was observed in F. hepatica but cross-reactivity with C. daubneyi was not seen. Faecal samples that contained rumen fluke eggs but not liver fluke eggs were all negative by cELISA. We conclude that C. daubneyi is the most common rumen fluke of domestic ruminants in Scotland and that cELISA reduction testing may be a valuable alternative to FECRT in herds or flocks that are co-infected with liver and rumen fluke., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician., Objective: The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application., Design: A cross-sectional study was conducted., Methods: Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes., Results: In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more "history/background probes," more "advice/suggestion," and less "restatement" than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%)., Limitations: Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded., Conclusion: This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (i.e., Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience.

Extremely large optical telescopes are being designed with primary mirrors composed of hundreds of segments. The "out-of-plane" piston, tip, and tilt degrees of freedom of each segment are actively controlled using feedback from relative height measurements between neighboring segments. The "in-plane" segment translations and clocking (rotation) are not actively controlled; however, in-plane motions affect the active control problem in several important ways, and thus need to be considered. We extend earlier analyses by constructing the "full" interaction matrix that relates the height, gap, and shear motion at sensor locations to all six degrees of freedom of segment motion, and use this to consider three effects. First, in-plane segment clocking results in height discontinuities between neighboring segments that can lead to a global control system response. Second, knowledge of the in-plane motion is required both to compensate for this effect and to compensate for sensor installation errors, and thus, we next consider the estimation of in-plane motion and the associated noise propagation characteristics. In-plane motion can be accurately estimated using measurements of the gap between segments, but with one unobservable mode in which every segment clocks by an equal amount. Finally, we examine whether in-plane measurements (gap and/or shear) can be used to estimate out-of-plane segment motion; these measurements can improve the noise multiplier for the "focus-mode" of the segmented-mirror array, which involves pure dihedral angle changes between segments and is not observable with only height measurements.

Shack-Hartmann (S-H) phasing of segmented telescopes is based upon a physical optics generalization of the geometrical optics Shack-Hartmann test, in which each S-H lenslet straddles an intersegment edge. For the extremely large segmented telescopes currently in the design stages, one is led naturally to very large pupil demagnifications for the S-H phasing cameras. This in turn implies rather small Fresnel numbers F for the lenslets; the nominal design for the Thirty Meter Telescope calls for F=0.6. For such small Fresnel numbers, it may be possible to eliminate the lenslets entirely, replacing them with a simple mask containing a sparse array of clear subapertures and thereby also eliminating a number of manufacturing problems and experimental complications associated with lenslets. We present laboratory results that demonstrate the validity of this approach.

Irrigation of rice fields in Bangladesh with arsenic-contaminated groundwater transfers tens of cubic kilometers of water and thousands of tons of arsenic from aquifers to rice fields each year. Here we combine observations of infiltration patterns with measurements of porewater chemical composition from our field site in Munshiganj Bangladesh to characterize the mobility of arsenic in soils beneath rice fields. We find that very little arsenic delivered by irrigation returns to the aquifer, and that recharging water mobilizes little, if any, arsenic from rice field subsoils. Arsenic from irrigation water is deposited on surface soils and sequestered along flow paths that pass through bunds, the raised soil boundaries around fields. Additionally, timing of flow into bunds limits the transport of biologically available organic carbon from rice fields into the subsurface where it could stimulate reduction processes that mobilize arsenic from soils and sediments. Together, these results explain why groundwater irrigated rice fields act as net sinks of arsenic from groundwater.

In Bangladesh, irrigation of dry season rice (boro) with arsenic-contaminated groundwater is leading to increased As levels in soils and rice, and to concerns about As-induced yield reduction. Arsenic concentrations and speciation in soil porewater are strongly influenced by redox conditions, and thus by water management during rice growth. We studied the dynamics of As, Fe, P, Si, and other elements in porewater of a paddy field near Sreenagar (Munshiganj), irrigated according to local practice, in which flooding was intermittent. During early rice growth, As porewater concentrations reached up to 500 μg L(-1) and were dominated by As(III), but As release was constrained to the lower portion of the soil above the plow pan. In the later part of the season, soil conditions were oxic throughout the depth range relevant to rice roots and porewater concentrations only intermittently increased to ∼150 μg L(-1) As(V) following irrigation events. Our findings suggest that intermittent irrigation, currently advocated in Bangladesh for water-saving purposes, may be a promising means of reducing As input to paddy soils and rice plant exposure to As.

An understanding of wind speed and direction as a function of height are critical to the proper modeling of atmospheric turbulence. We have used radiosonde data from launch sites near significant astronomical observatories and created averaged profiles of wind speed and direction and have also computed Richardson number profiles. Using data from the last 30 years, we confirm a 1977 Greenwood wind profile, and extend it to include parameters that show seasonal variations and differences in location. The added information from our models is useful for the design of adaptive optics systems and other imaging systems. Our analysis of the Richardson number suggests that persistent turbulent layers may be inferred when low values are present in our long term averaged data. Knowledge of the presence of these layers may help with planning for adaptive optics and laser communications.

Groundwater rich in arsenic (As) is extensively used for dry season boro rice cultivation in Bangladesh, leading to long-term As accumulation in soils. This may result in increasing levels of As in rice straw and grain, and eventually, in decreasing rice yields due to As phytotoxicity. In this study, we investigated the As contents of rice straw and grain over three consecutive harvest seasons (2005-2007) in a paddy field in Munshiganj, Bangladesh, which exhibits a documented gradient in soil As caused by annual irrigation with As-rich groundwater since the early 1990s. The field data revealed that straw and grain As concentrations were elevated in the field and highest near the irrigation water inlet, where As concentrations in both soil and irrigation water were highest. Additionally, a pot experiment with soils and rice seeds from the field site was carried out in which soil and irrigation water As were varied in a full factorial design. The results suggested that both soil As accumulated in previous years and As freshly introduced with irrigation water influence As uptake during rice growth. At similar soil As contents, plants grown in pots exhibited similar grain and straw As contents as plants grown in the field. This suggested that the results from pot experiments performed at higher soil As levels can be used to assess the effect of continuing soil As accumulation on As content and yield of rice. On the basis of a recently published scenario of long-term As accumulation at the study site, we estimate that, under unchanged irrigation practice, average grain As concentrations will increase from currently ∼0.15 mg As kg(-1) to 0.25-0.58 mg As kg(-1) by the year 2050. This translates to a 1.5-3.8 times higher As intake by the local population via rice, possibly exceeding the provisional tolerable As intake value defined by FAO/WHO.

Shallow groundwater, often rich in arsenic (As), is widely used for irrigation of dry season boro rice in Bangladesh. In the long term, this may lead to increasing As contents in rice paddy soils, which threatens rice yields, food quality, and human health. The objective of this study was to quantify gains and losses of soil As in a rice paddy field during irrigation and monsoon flooding over a three-year period. Samples were collected twice a year on a 3D-sampling grid to account for the spatially heterogeneous As distribution within the soil. Gains and losses of soil As in different depth segments were calculated using a mass-balance approach. Annual As input with irrigation water was estimated as 4.4 +/- 0.4 kg ha(-1) a(-1). Within the top 40 cm of soil, the mean As accumulation over three years amounted to 2.4 +/- 0.4 kg ha(-1) a(-1), implying that on average 2.0 kg ha(-1) a(-1) were lost from the soil. Seasonal changes of soil As showed that 1.05 to 2.1 kg ha(-1) a(-1) were lost during monsoon flooding. The remaining As-loss (up to 0.95 kg ha(-1) a(-1)) was attributed to downward flow with percolating irrigation water. Despite these losses, we estimate that total As within the top 40 cm of soil at our field site would further increase by a factor of 1.5 to 2 by the year 2050 under current cultivation practices.

Compensation of extended (deep) turbulence effects is one of the most challenging problems in adaptive optics (AO). In the AO approach described, the deep turbulence wave propagation regime was achieved by imaging stars at low elevation angles when image quality improvement with conventional AO was poor. These experiments were conducted at the U.S. Air Force Maui Optical and Supercomputing Site (AMOS) by using the 3.63 m telescope located on Haleakala, Maui. To enhance compensation performance we used a cascaded AO system composed of a conventional AO system based on a Shack-Hartmann wavefront sensor and a deformable mirror with 941 actuators, and an AO system based on stochastic parallel gradient descent optimization with four deformable mirrors (75 control channels). This first-time field demonstration of a cascaded AO system achieved considerably improved performance of wavefront phase aberration compensation. Image quality was improved in a repeatable way in the presence of stressing atmospheric conditions obtained by using stars at elevation angles as low as 15 degrees.

Around 38% of the area of Bangladesh is irrigated with groundwater to grow dry season crops, most importantly boro rice. Due to high As concentrations in many groundwaters, over 1000 tons of As are thus transferred to arable soils each year, creating a potential risk for future food production. We studied the reactions and changing speciation of As, Fe, P, and other elements in initially anoxic water during and after irrigation and the resulting spatial distribution of As input to paddy soils near Sreenagar (Munshiganj), 30 km south of Dhaka, in January and April 2005 and February 2006. The irrigation water had a constant concentration of 397 +/- 7 microg L(-1) As (approximately 84% As(III)), 11 +/- 0.1 mg L(-1) Fe, and 2 +/- 0.1 mg L(-1) P. During the fast flow along the longest irrigation channel (152 m) As, Fe, and P speciation changed, but total concentrations did not decrease significantly, indicating that As input to fields was independent of the length of the irrigation channels. In contrast, during slow water flow across the fields, As, Fe, and P concentrations decreased strongly with increasing distance from the water inlet, due to formation and settling of As- and P-bearing Fe aggregates and by adsorption to soil minerals. Total As concentrations in field water were approximately 3 times higher close to the inlet than in the opposite field corner shortly after irrigation, and decreased to below 35 microg L(-1) over the next 72 h. The laterally heterogeneous transfer of As, Fe, and P from irrigation waterto soil has important consequences for their distribution in irrigated fields and needs to be considered in sampling and in assessing the dynamics and mass balances of As fluxes among irrigation water, soil, and floodwater.

Arsenic-rich groundwater from shallow tube wells is widely used for the irrigation of boro rice in Bangladesh and West Bengal. In the long term this may lead to the accumulation of As in paddy soils and potentially have adverse effects on rice yield and quality. In the companion article in this issue, we have shown that As input into paddy fields with irrigation water is laterally heterogeneous. To assess the potential for As accumulation in soil, we investigated the lateral and vertical distribution of As in rice field soils near Sreenagar (Munshiganj, Bangladesh) and its changes over a 1 year cycle of irrigation and monsoon flooding. At the study site, 18 paddy fields are irrigated with water from a shallow tube well containing 397 +/- 7 microg L(-1) As. The analysis of soil samples collected before irrigation in December 2004 showed that soil As concentrations in paddy fields did not depend on the length of the irrigation channel between well and field inlet. Within individual fields, however, soil As contents decreased with increasing distance to the water inlet, leading to highly variable topsoil As contents (11-35 mg kg(-1), 0-10 cm). Soil As contents after irrigation (May 2005) showed that most As input occurred close to the water inlet and that most As was retained in the top few centimeters of soil. After monsoon flooding (December 2005), topsoil As contents were again close to levels measured before irrigation. Thus, As input during irrigation was at least partly counteracted by As mobilization during monsoon flooding. However, the persisting lateral As distribution suggests net arsenic accumulation over the past 15 years. More pronounced As accumulation may occur in regions with several rice crops per year, less intense monsoon flooding, or different irrigation schemes. The high lateral and vertical heterogeneity of soil As contents must be taken into account in future studies related to As accumulation in paddy soils and potential As transfer into rice.

Arsenic removal by passive treatment, in which naturally present Fe(II) is oxidized by aeration and the forming iron(III) (hydr)oxides precipitate with adsorbed arsenic, is the simplest conceivable water treatment option. However, competing anions and low iron concentrations often require additional iron. Application of Fe(II) instead of the usually applied Fe(III) is shown to be advantageous, as oxidation of Fe(II) by dissolved oxygen causes partial oxidation of As(III) and iron(III) (hydr)oxides formed from Fe(II) have higher sorption capacities. In simulated groundwater (8.2 mM HCO3(-), 2.5 mM Ca2+, 1.6 mM Mg2+, 30 mg/L Si, 3 mg/L P, 500 ppb As(III), or As(V), pH 7.0 +/- 0.1), addition of Fe(II) clearly leads to better As removal than Fe(III). Multiple additions of Fe(II) further improved the removal of As(II). A competitive coprecipitation model that considers As(III) oxidation explains the observed results and allows the estimation of arsenic removal under different conditions. Lowering 500 microg/L As(III) to below 50 microg/L As(tot) in filtered water required > 80 mg/L Fe(III), 50-55 mg/L Fe(II) in one single addition, and 20-25 mg/L in multiple additions. With As(V), 10-12 mg/L Fe(II) and 15-18 mg/L Fe(III) was required. In the absence of Si and P, removal efficiencies for Fe(II) and Fe(III) were similar: 30-40 mg/L was required for As(II), and 2.0-2.5 mg/L was required for As(V). In a field study with 22 tubewells in Bangladesh, passive treatment efficiently removed phosphate, but iron contents were generally too low for efficient arsenic removal.

Stellar occultations--the passing of a relatively nearby body in front of a background star--can be used to probe the atmosphere of the closer body with a spatial resolution of a few kilometres (ref. 1). Such observations can yield the scale height, temperature profile, and other information about the structure of the occulting atmosphere. Occultation data acquired for Pluto's atmosphere in 1988 revealed a nearly isothermal atmosphere above a radius of approximately 1,215 km. Below this level, the data could be interpreted as indicating either an extinction layer or the onset of a large thermal gradient, calling into question the fundamental structure of this atmosphere. Another question is to what extent Pluto's atmosphere might be collapsing as it recedes from the Sun (passing perihelion in 1989 in its 248-year orbital period), owing to the extreme sensitivity of the equilibrium surface pressure to the surface temperature. Here we report observations at a variety of visible and infrared wavelengths of an occultation of a star by Pluto in August 2002. These data reveal evidence for extinction in Pluto's atmosphere and show that it has indeed changed, having expanded rather than collapsed, since 1988.

Patients undergoing orthotopic liver transplantation (OLT) are susceptible to massive blood loss and require transfusion. Possible reasons for increased transfusion demands include platelet abnormalities, thrombocytopenia secondary to hypersplenism, clotting factor deficiencies, fibrinolysis, increased surgical blood loss associated with portal hypertension and previous surgical procedures, and hypothermia. The purpose of this study was to review trends in blood product usage during our first 6 years of experience performing OLT.

Brain death is accompanied by a loss of homeostatic mechanisms leading to physiologic changes which have been shown to be detrimental to donor organs prior to procurement. The management of the brain dead organ donor (BDOD) is frequently left to transplant coordinators, often registered nurses, who follow standardized protocols for that management. The use of a standardized protocol assumes that these donors display homogeneity. To investigate this assumption, the anesthesiology fellows and faculty involved in multiorgan transplantation at the Baylor University Medical Center/UTSWMC conducted a study into the perioperative hemodynamics of the BDOD.

Patients undergoing orthotopic liver transplantation frequently receive dopamine infusions to preserve renal function. To test the benefit of such infusions on renal function, 48 nonanuric patients presenting for OLT were entered into a randomized double-blind protocol. After exclusion of 1 patient for intraoperative nephrectomy, 22 patients received dopamine at a rate of 3 micrograms.kg-1.min-1 during surgery and the first postoperative 48 h, and a control group of 25 patients received saline. Venovenous bypass was used in 45 of 47 patients. During the hepatic vascular anastomoses, the donor liver was flushed with cold saline. In 7 patients, the flush contained mannitol (50 g) as part of a surgical protocol to investigate its role as a potential free radical scavenger. Initially, it appeared that there was an increase in urine output during the neohepatic phase in those patients receiving dopamine versus controls (4.20 +/- 3.3 vs 2.10 +/- 1.3 ml.kg-1.h-1, respectively). Upon further statistical analysis, this increase was associated with inclusion of mannitol in the liver flush of 5 patients in the dopamine group. After excluding all patients receiving flush containing mannitol, there was no significant difference in urine output during the neohepatic phase between the dopamine group and controls (2.94 +/- 0.45 and 2.10 +/- 0.28 ml.kg-1.h-1, respectively). The glomerular filtration rates at 1 month after surgery were similar and decreased approximately 40% in each group. Although a beneficial effect of dopamine in all situations cannot be ruled out the authors conclude that routine perioperative use of dopamine is of little value in nonanuric patients presenting for orthotopic liver transplantation.