Search

Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.

Anticipated nostalgia is the foreseeing of looking back on life events and expecting to feel nostalgic about it in the future. I review recent findings on the content, affective profile, and psychological benefits of anticipated nostalgia. I also review neurological and cognitive evidence that may explain the mechanism underlying anticipated nostalgia. Finally, I discuss anticipated nostalgia in an applied setting, consumer behavior., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. None., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Affective ambivalence is the simultaneous experience of oppositely valenced emotions, such as happiness and sadness. Historic writings on the valence of nostalgia have proposed that nostalgia can best be conceptualized as an ambivalent emotion. A growing body of research provides empirical evidence for this proposal. Here, I review and summarize this evidence that nostalgia is an ambivalent emotion, albeit more positive than negative. I end by discussing implications and future research directions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Scholars have proposed that nostalgia plays various important roles in organizations. At present, there is no comprehensive overview of the role of nostalgia in this context. To help develop such an overview, we review research on personal nostalgia, insofar as it includes outcomes that are organizationally relevant, and research on organizational nostalgia. We propose a model that summarizes the processes through which nostalgia operates in organizations. In this model, we propose that threatening circumstances such as injustice or organizational change evoke organizational (and possibly personal) nostalgia, this evoked nostalgia subsequently counteracts the negative effects of threat on outcomes such as organizational identification and experienced work meaningfulness. We end by discussing implications and future research directions., Competing Interests: Conflict of interest The authors have no conflict of interest to declare., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The Narratives of Neurodiversity Network (NNN) is a neurodivergent academic, creative, and educator collective that came together with allies during the Covid-19 pandemic to create a network centred around emerging narratives about neurodiversity and exploring new ways of learning and socialising. The network focuses on exploring the roles of written, spoken, and visual narratives across cultural locations about neuro-atypical experiences in generating improved agency and self-advocacy for those who have been subject to pathologization through neuro-normativity and intersecting oppression. During the last year, widening access to digital platforms has provided a space to explore these issues outside of traditional academic spaces. We run a monthly "Salon," our mixed-media "reading, listening, and watching" group, in an effort to find positive representation within contemporary culture. Discussions have moved beyond mimesis and into a consideration of how narrative and storyworlds can question the supposed naturalness of certain ways of being in and perceiving the world. This article interrogates the network's core principles of nonhierarchical co-production, including the roles of creativity, community, identity, and emancipatory research which were animated by the new techno-social context. We consider the cultural lives of neurodiversity in the West and beyond, including ethical and aesthetic dimensions. We share a faith in the power of storytelling to inform new social identities for neurodivergent people and to inform scientific understandings of atypical cognition. In exploring this, we speak through a porous first-person plural narrator, to unsettle the idea that there is a hegemonic "we" speaking on behalf of all neurodivergent people., Competing Interests: Conflict of Interests The authors declare no conflict of interests.

Background: Allergic diseases are increasing globally and are a significant public health challenge, especially in children. Cow's milk allergy (CMA) is one of the most common food allergies in early childhood. When CMA is diagnosed and exclusive breastfeeding is not possible, current guidelines recommend extensively hydrolyzed formulas (eHF) or amino acid-based formulas (AAF), depending on the diagnosis and severity of symptoms. Hydrolyzed rice formulas (HRF) are considered an alternative to eHF and AAF where available., Objectives & Methods: We aimed to understand how HRF are being used and their position in the management of CMA, and to generate consensus on indications for use. Two virtual roundtables of international healthcare experts in pediatric food allergy focused on HRF were convened in May and October 2021. Experts provided multiple perspectives due to different specialties, locations, healthcare settings, and availability of HRF. Following discussion of international CMA guidelines and HRF use, identification of challenges along the diagnosis and treatment pathway, and translation of guidelines into clinical practice, an expert consensus on the use of HRF for CMA was developed. This involved repeated voting followed by statement amendment to reach 100% agreement. This publication summarizes insights from these meetings., Results: There was 100% agreement on all 8 statements: (1) While breastmilk is the best source of nutrition for infants with CMA, when breastfeeding is not possible, a hypoallergenic formula can be used; (2) Per definition, a HRF is cow's milk protein-free; (3) A minority of infants with immunoglobulin (Ig)E-mediated CMA react to eHF due to residual cow's milk protein; (4) More infants with non-IgE-mediated CMA than IgE-mediated CMA react to eHF likely due to residual cow's milk protein; (5) When a diagnostic elimination diet is indicated, HRF can be used; (6) A HRF can be recommended as a first-line option for CMA, where available, as outlined in the Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines; (7) HRFs have proven hypoallergenicity and are suitable for the dietary management of CMA; (8) HRFs have been shown to support growth in infants with CMA, similar to other hypoallergenic formulas. Participants recommend healthcare professionals take these statements as guidance to use HRF in clinical practice. Based on efficacy and growth evidence, the experts found HRF a suitable option for the dietary management of CMA., Conclusion: HRF can be recommended as a first-line alternative to cow's milk-based eHF or AAF, where available, in the dietary management of CMA., (© 2022 The Authors.)

The endocannabinoid system (ECS) appears to regulate metabolic, cardiovascular, immune, gastrointestinal, lung, and reproductive system functions, as well as the central nervous system. There is also evidence that neuropsychiatric disorders are associated with ECS abnormalities as well as oxidative and nitrosative stress pathways. The goal of this mechanistic review is to investigate the mechanisms underlying the ECS's regulation of redox signalling, as well as the mechanisms by which activated oxidative and nitrosative stress pathways may impair ECS-mediated signalling. Cannabinoid receptor (CB)1 activation and upregulation of brain CB2 receptors reduce oxidative stress in the brain, resulting in less tissue damage and less neuroinflammation. Chronically high levels of oxidative stress may impair CB1 and CB2 receptor activity. CB1 activation in peripheral cells increases nitrosative stress and inducible nitric oxide (iNOS) activity, reducing mitochondrial activity. Upregulation of CB2 in the peripheral and central nervous systems may reduce iNOS, nitrosative stress, and neuroinflammation. Nitrosative stress may have an impact on CB1 and CB2-mediated signalling. Peripheral immune activation, which frequently occurs in response to nitro-oxidative stress, may result in increased expression of CB2 receptors on T and B lymphocytes, dendritic cells, and macrophages, reducing the production of inflammatory products and limiting the duration and intensity of the immune and oxidative stress response. In conclusion, high levels of oxidative and nitrosative stress may compromise or even abolish ECS-mediated redox pathway regulation. Future research in neuropsychiatric disorders like mood disorders and deficit schizophrenia should explore abnormalities in these intertwined signalling pathways., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: It has been shown that autonomic dysfunction in fibromyalgia can be assessed by the Composite Autonomic Symptom Score (COMPASS) questionnaire. More recently, a refined and much abbreviated 31-item version of the questionnaire has been developed, the COMPASS 31., Objectives: First, to determine whether the COMPASS 31 can assess changes in autonomic function in fibromyalgia. Second, to assess whether the COMPASS 31 values in fibromyalgia patients are positively correlated with scores on the Revised Fibromyalgia Impact Questionnaire (FIQR)., Methods: A cross-sectional, case-controlled study was carried out with 25 fibromyalgia patients and 26 healthy controls., Results: The two groups were matched for age, sex and ethnicity, but not for body mass index (BMI). The total mean (standard error) COMPASS 31 for the fibromyalgia patients, 37.2 (1.8), differentiated the patients from the controls (9.5 (1.4); p < 0.00000001). The scores were greater in the fibromyalgia patients across all COMPASS 31 autonomic domains, namely orthostatic intolerance (p < 0.00000001), and vasomotor (p < 0.0001), secretomotor (p < 0.000001), gastrointestinal (p < 0.000001), bladder (p < 0.00001) and pupillomotor functions (p < 0.00000001). The total COMPASS 31 values were positively correlated with FIQR scores (r s = 0.45, p < 0.05). General linear modelling of the COMPASS 31 scores showed that only group status (fibromyalgia or control) was significant (p = 3.4 × 10 -16 ), with age, sex and BMI being non-significant., Conclusion: This study confirms that non-pain autonomic dysfunction symptoms occur in fibromyalgia and can be assessed with the COMPASS 31., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: To assess the impact of tinnitus in fibromyalgia., Methods: A quantitative controlled study was carried out. The 25-item Tinnitus Handicap Inventory (THI) and the Revised Fibromyalgia Impact Questionnaire (FIQR) were administered to 27 patients who fulfilled the revised diagnostic criteria for fibromyalgia of the American College of Rheumatology and to 26 healthy controls who had no history of suffering from fibromyalgia or any other rheumatological or neurological illness., Results: The two groups were matched for age, sex and ethnicity. The fibromyalgia patients were significantly more likely to suffer from tinnitus than the controls: 16 (59.3%) of the patients suffered from tinnitus, compared with two (7.7%) of the controls (p < 0.001). The median (interquartile range) total THI score for the fibromyalgia group was 6 (44), which was significantly higher than that of 0 (0) for the control group (p < 0.001). The fibromyalgia group scored significantly higher than the control group for 24 of the 25 THI items. The total THI score across all subjects was positively correlated with the FIQR scores (rs = 0.408, p = 0.002)., Conclusion: Fibromyalgia is associated with a relatively high prevalence of tinnitus.

There is growing awareness across the neuroscience community that the replicability of findings about the relationship between brain activity and cognitive phenomena can be improved by conducting studies with high statistical power that adhere to well-defined and standardised analysis pipelines. Inspired by recent efforts from the psychological sciences, and with the desire to examine some of the foundational findings using electroencephalography (EEG), we have launched #EEGManyLabs, a large-scale international collaborative replication effort. Since its discovery in the early 20th century, EEG has had a profound influence on our understanding of human cognition, but there is limited evidence on the replicability of some of the most highly cited discoveries. After a systematic search and selection process, we have identified 27 of the most influential and continually cited studies in the field. We plan to directly test the replicability of key findings from 20 of these studies in teams of at least three independent laboratories. The design and protocol of each replication effort will be submitted as a Registered Report and peer-reviewed prior to data collection. Prediction markets, open to all EEG researchers, will be used as a forecasting tool to examine which findings the community expects to replicate. This project will update our confidence in some of the most influential EEG findings and generate a large open access database that can be used to inform future research practices. Finally, through this international effort, we hope to create a cultural shift towards inclusive, high-powered multi-laboratory collaborations., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Peristomal skin complications (PSCs) impair life for people with an ostomy. Visual signs of PSCs include discolouration, but sensation symptoms like pain, itching, and burning are equally important and underreported., Aim: To provide improved understanding of PSC prevalence and associated challenges in the communities of ostomy patients and ostomy care nurses., Methods: The Ostomy Life Study 2019 encompassed a patient survey (completed by 5187 people with an ostomy) and a nurse survey (completed by 328 ostomy care nurses)., Findings: In total, 88% of patients experienced PSCs and 75% experienced PSC symptoms in the absence of discolouration. Eighty per cent of nurses considered ostomy-related issues to be the main reason for PSCs, and a correlation between PSC severity and number of nurse consultations was demonstrated., Conclusion: This study revealed a remarkably high PSC incidence in the absence of discolouration and highlighted direct consequences of having compromised skin and the health-economic consequences.

Fascist dictator Francisco Franco was responsible for the torture, murder and covert burial of 150-200,000 civilians both during and after the Spanish Civil War (1936-1939). This comprises one of the largest concentrations of mass graves and victims in the world, yet efforts to exhume them have been strenuously blocked by subsequent governments. This research documents the 2017 exhumation of Timoteo Mendieta Alcalá and 27 other individuals executed between July and November 1939, and interred at the cemetery in Guadalajara, Castilla La Mancha. The analysis includes DNA identifications and an assessment of cultural (possessions) and bioarchaeological variables (age/sex, stature, palaeopathology) in order to contextualise studies of ante/peri-mortem trauma, and thus understand the decedents' lives and the manner in which they were treated before and up to the time of their executions. Of the 24 burials in the main grave, 23 (95.8%) showed gunshot trauma (GSW), 7 (29.2%) showed blunt force trauma (BFT) and 1 (4.2%) showed sharp force trauma (SFT). Five of the main group (20.8%) showed healing lesions indicative of often extensive assault in the weeks leading up to their execution; one individual had sustained 27 fractures. GSW patterns are consistent with an organised firing squad, followed by multiple GSW at close range in the back/side of the head. This research elucidates unrecorded aspects of fascist dominion in 1936-9, adds to extant research on pattern and method in global atrocities, and demonstrates the human cost of the Spanish Civil War to those who aim to trivialise it., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier B.V.)

Background and Aims: Malnutrition is prevalent in oesophageal cancer. Evidence for the use of nutrition support and prehabilitation in this cohort is variable. The aim of this study was to examine the effect of early nutrition support and functional measures of nutritional status on post-operative outcomes in adult patients with oesophageal cancer., Methods: Retrospective review of adults with oesophageal cancer undergoing oesophagectomy (n = 151). Early nutrition support was defined as: oral or enteral nutrition supplementation during neoadjuvant treatment. Late nutrition support defined as: oral or enteral nutrition supplementation prescribed post-operatively. Nutrition outcome measures were; percentage weight loss from 3 to 6 months prior to diagnosis, peri- and post-operatively, and pre-operative assessment of handgrip-strength (HGS)., Results: Pre-operative weight loss ≥10% was a significant predictor of mortality at 1 year (OR 2.84, 95%CI 1.03-7.83, p = 0.04) independent of tumour stage, adjuvant treatment, age and gender. Adults prescribed early nutrition support during neoadjuvant treatment experienced less weight loss at 12-months post-oesophagectomy compared to adults prescribed late oral nutrition support (p=<0.05). Pre-operative HGS measurements were not a useful predictor of postoperative complications (p = 0.2), length of stay (p = 0.9) or 90-day mortality (p = 0.6)., Conclusions: Pre-operative weight loss ≥10% was associated with mortality. Early nutrition support was associated with less weight loss at 12-months post-operatively. Pre-operative HGS measures did not have prognostic value as a stand-alone measure. Future work should investigate the efficacy of early nutrition support in reducing both pre- and post-operative weight loss to improve nutritional status and surgical outcomes as part of a multimodal prehabilitation programme in adults with oesophageal cancer., Competing Interests: Declaration of competing interest None of the authors has any conflict of interest to declare in relation to this quality improvement project., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To assess physical activity (PA), mental health and well-being of adults in the United Kingdom (UK), Ireland, New Zealand and Australia during the initial stages of National governments' Coronavirus disease (COVID-19) containment responses., Design: Observational, cross-sectional., Methods: An online survey was disseminated to adults (n=8,425; 44.5±14.8y) residing in the UK, Ireland, New Zealand and Australia within the first 2-6 weeks of government-mandated COVID-19 restrictions. Main outcome measures included: Stages of Change scale for exercise behaviour change; International Physical Activity Questionnaire (short-form); World Health Organisation-5 Well-being Index; and the Depression Anxiety and Stress Scale-9., Results: Participants who reported a negative change in exercise behaviour from before initial COVID-19 restrictions to during the initial COVID-19 restrictions demonstrated poorer mental health and well-being compared to those demonstrating either a positive-or no change in their exercise behaviour (p<0.001). Whilst women reported more positive changes in exercise behaviour, young people (18-29y) reported more negative changes (both p<0.001). Individuals who had more positive exercise behaviours reported better mental health and well-being (p<0.001). Although there were no differences in PA between countries, individuals in New Zealand reported better mental health and well-being (p<0.001)., Conclusion: The initial COVID-19 restrictions have differentially impacted upon PA habits of individuals based upon their age and sex, and therefore have important implications for international policy and guideline recommendations. Public health interventions that encourage PA should target specific groups (e.g., men, young adults) who are most vulnerable to the negative effects of physical distancing and/or self-isolation., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Although the concept of maintaining a period of 'nil by mouth' following head and neck reconstruction is commonly held ideas on delaying function have changed dramatically since the introduction of peri-operative care recovery programmes. This study sought to evaluate the outcomes of early feeding on patients undergoing free flap reconstruction of oral defects with particular emphasis on post-operative complications and length of stay., Methods: Data was gathered prospectively on two cohorts of patients treated in a tertiary referral centre comparing those undergoing a five-day post-operative period of 'nil by mouth' with a second group in which the aim was to start fluids and soft diet on the day following surgery. Complications and length of stay were evaluated., Results: Both early and late feeding groups comprised of 200 patients. No significant differences were observed in terms of age, gender, smoking and alcohol use or tumour T and N stages between the two groups. 8% of patients had complications at the recipient site but no difference was observed in the rates of flap dehiscence or fistula formation between the two groups. Early feeding was associated with a statistically reduced length of hospital stay (mean 11.6 days vs 20.6 days, p < 0.01)., Conclusions: Early oral feeding following head and neck free flap reconstruction is not associated with an increase incidence of peri-operative complications but reduces hospital stay. The latter may have far-reaching implications for patients' physical and psychological well-being in addition to health care resources., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The marketization of higher education (HE), which positions students as consumers and academics as service providers, may adversely affect students' motivation for learning and academics' motivation for teaching. According to self-determination theory (SDT), high-quality forms of motivation are achieved when individuals experience fulfilment of three psychological needs: competence, autonomy, and relatedness., Aims: This study applied SDT to examine academics' perceptions of whether the marketized HE context in England, UK, supported or undermined these three psychological needs for their students and for themselves. It also examined their perceptions of the impact that this context had on their teaching., Sample: Participants were 10 academics teaching at five post-1992 HE institutions in England, UK., Method: Semi-structured interviews were conducted and subsequently analysed using thematic analysis., Results: Academics observed that students identifying as consumers seemed to display lower levels of competence, autonomy, and relatedness. This contributed to an HE environment that diminished the academics' own psychological needs. Although some felt able to improve student motivation through their teaching, others felt demotivated and disempowered by top-down pressure from managers and bottom-up pressure from students., Conclusions: The marketized HE context may undermine high-quality motivation for students' learning and academics' teaching. Academics should be supported to teach in ways that facilitate competence, autonomy, and relatedness in their students and themselves., (© 2019 The British Psychological Society.)

Emotional contagion has been recognized as a variable influencing individual behaviour and team functioning. In particular, leaders within the team have been suggested to have a significant impact on their teammates through the expression of their emotions. As a result, the aim of this study was to provide greater insight into how different athlete leaders impact the emotional state of their team members, and whether gender differences existed in these relationships. Participants were 295 university student-athletes (200 male and 95 female) recruited from four universities in the UK. Data were collected in a two-step process. First, a voting/rating procedure was conducted within team to identify dominant task, motivational, social and external leaders. Then, participants completed the emotional contagion subscale of the Measure of Empathetic Tendency to rate the impact different athlete leaders had upon their emotional state. A MANOVA was conducted to explore gender differences in reported emotional susceptibility by leadership role. Subsequent ANOVAs highlighted significant differences between leadership role scores for female participants only. The results suggest that female athletes are more susceptible to emotional influence than male athletes. Furthermore, female athletes experienced a greater variation in the perceived emotional influence of different leadership roles in the team.

Background: Asperger syndrome (AS) is part of a spectrum of disorders encompassing difficulties with social interaction that may result in specific educational needs for doctors in training. There is currently limited research on the impact of AS on working as a doctor., Methods: This is a qualitative study using semi-structured interviews to explore the perceptions of trainees diagnosed with AS following input from a professional support service, and the perspectives of the staff involved in their professional development., Findings: Receiving a diagnosis of AS was viewed as a double-edged sword, allowing the development of insight into lifelong difficulties, but also creating the potential for prejudice. Understanding AS traits provided an explanation for challenges in the workplace and therefore opportunities to find solutions. Understanding AS traits provided an explanation for challenges in the workplace DISCUSSION: This study explores the benefits and disadvantages of defining and labelling a specific professional support need for a group of trainees. It also reveals the need for improved awareness of AS amongst all clinical educators., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Previous research suggests impaired metacognitive monitoring and mathematics under-achievement in autism spectrum disorder. Within educational settings, metacognitive monitoring is supported through the provision of feedback (e.g. with goal reminders and by explicitly correcting errors). Given the strength of the relationship between metacognition, learning and educational attainment, this research tested new computer-based metacognitive support (the 'Maths Challenge') for mathematics learners with autism spectrum disorder within the context of their classroom. The Maths Challenge required learners to engage in metacognitive monitoring before and after answering each question (e.g. intentions and judgements of accuracy) and negotiate with the system the level of difficulty. Forty secondary school children with autism spectrum disorder and 95 typically developing learners completed the Maths Challenge in either a Feedback condition, with metacognitive monitoring support regarding the accuracy of their answers, goal reminders and strategy support, or with No Feedback. Contrary to previous findings, learners with autism showed an undiminished ability to detect errors. They did, however, demonstrate reduced cohesion between their pre- and post-test intentions. Crucially, support from the Feedback condition significantly improved task performance for both groups. Findings highlight important implications for educational interventions regarding the provision of metacognitive support for learners with autism to ameliorate under-performance in mathematics within the classroom.

Background Improving the quality of care for people with dementia in general hospitals is a key priority. Creative activities including music have been examined for their potential role in enhancing quality of life for people with dementia, although relatively few studies have evaluated their use in acute hospital settings. Methods A mixed methods study examined the effects of a ten week period of weekly music sessions on the wellbeing of patients with dementia and on the ward environment in an acute elderly care service in a UK hospital. Potential effects of the music project on the ward environment were examined by comparing descriptive quantitative ward level data for two equivalent time periods, one with music and one with no music. The impact of the activity on participants' wellbeing was assessed using observational data as well as semi-structured interviews and focus groups with patients, visitors, the musician and staff. Results Ward level data were available for 85 patients with a dementia diagnosis who had stayed on the wards during the study periods. Comparison between the two periods showed a number of differences between the music and the non-music time periods, including a reduction in prescription of antipsychotic drugs. However, many factors could have contributed to the differences in the ward environment. Observational data revealed nuanced responses to music and suggested that participants generally enjoyed the activity. The impacts of music making were mediated strongly by staff responses and hospital organisation. Conclusion Data from this limited pilot study suggest that music is a useful intervention for enhancing patient and staff experiences and improving care in acute dementia care environments. The suggestion that use of anti-psychotic drugs may be reduced when music is present warrants further research.

Dedicated clinical skills laboratories (CSLs) that make use of models, mannequins and simulators, are being increasingly established in medical and veterinary schools. These have been commonplace in medical schools for more than two decades, but their incorporation within the teaching of veterinary curricula has occurred much more recently. In 2007, a decision was taken to establish a CSL at Ross University School of Veterinary Medicine. We considered the range of skills that we wished to teach, the physical space and equipment needed, the storage and air conditioning requirements, the facilities needed to deliver PowerPoint lectures and case study presentations, and other essentials necessary to handle cadaver specimens. We converted an appropriate campus building to our needs, hired teaching staff, and started to source models and mannequins for the teaching of veterinary clinical skills. In 2010, 177 senior students completed a survey evaluating their experiences within our CSL. Student satisfaction was generally high, with 95% of respondents feeling that the CSL had improved their psychomotor skills. However, 15% of them felt that the models were insufficiently realistic. Our clinical skills programme has since developed considerably, and it currently offers instruction in a diverse array of surgical, medical and other clinical skills. We hope that this description of our experiences may assist others embarking on similar projects elsewhere.

Background and Aims: The between-day reliability of oscillometric pulse wave analysis has been demonstrated in a young, healthy population but not in an older sample. This study examined the between-day reliability of the SphygmoCor XCEL in individuals over 50 years. As blood pressure is measured in a range of postures and fasting states (supine/seated, fasted/non-fasted), this study also investigated the effect of these variables on central blood pressure and central systolic loading., Methods: Fifty-one adults (m = 21; age 57 ± 6.4 y) were tested on three mornings in supine and seated conditions and in fasted and non-fasted states. Data was analysed as a whole and for normotensive (n = 25) and hypertensive participants (n = 26)., Results: SphygmoCor XCEL demonstrated strong reliability in the whole sample for central systolic and diastolic blood pressures, augmentation index (AIx) and AIx75 (ICC = 0.77-0.95). Significant interaction effects were observed in central diastolic blood pressure, central pulse pressure, augmentation index (AIx) and AIx75 (p < 0.05; η p 2  = 0.10-0.23). Fasting state had a greater influence on central pressures in a seated than supine posture, but a greater effect on central systolic loading measures in a supine posture., Conclusions: The SphygmoCor XCEL is a reliable tool to assess central haemodynamic variables in an older population. It would be pertinent for clinicians and researchers to record central measures in a supine posture to minimise the effects of food consumption. Conversely, the assessment of central systolic loading should occur in a seated condition to minimise the influence of varying fasting states., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non-governmental status. Future policy and research priorities are outlined. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Research on the psychology of conspiracy theories has shown recent steps towards a standardization of measures. The present article seeks to continue that trend by presenting the Flexible Inventory of Conspiracy Suspicions (FICS), a questionnaire template that can be adapted to measure suspicions of a conspiracy around nearly any topic of public interest. Compared to conspiracy belief measures that ask about specific theories on a given topic, the FICS is worded in such a way as to provide relatively stable validity across time and cultural context. Using a hybrid approach incorporating classical test theory and Rasch scaling, three questionnaire studies on Mechanical Turk demonstrate the validity of the FICS in measuring conspiracy suspicions regarding 9/11, vaccine safety, and US elections, with good psychometric properties in most situations. However, the utility of the FICS is limited in the case of climate change due to the existence of two opposing conspiracy theories that share essentially no common assumptions ('climate change is a hoax' vs. 'there is a conspiracy to make people believe that climate change is a hoax'). The results indicate that the FICS is a reliable and valid measure of conspiracy suspicions within certain parameters, and suggest a three-level model that differentiates general conspiracist ideation, relatively vague conspiracy suspicions, and relatively specific conspiracy beliefs., (© 2016 The British Psychological Society.)

As children's natural activity patterns are highly intermittent in nature, and characterised by rapid changes from rest to vigorous physical activity, discontinuous exercise tests may be considered ecologically valid for this population group. This study compared the peak physiological responses from a discontinuous and continuous graded exercise test (GXT&#95;D, GXT&#95;C, respectively) during treadmill exercise in children. Twenty-one healthy children (9.6 ± 0.6 y) completed GXT&#95;D and GXT&#95;C in a randomised order, separated by 72-hours. Following each GXT, and after a 15-minute recovery, participants completed a verification test at 105% of the velocity attained at peak oxygen consumption (VO 2 peak). There were no differences in VO 2 peak (55.3 ± 8.2 cf. 54.4 ± 7.6 mL·kg -1 ·min -1 ) or maximal heart rate (202 ± 10 cf. 204 ± 8 b·min -1 ) between GXT&#95;C and GXT&#95;D, respectively (P>.05). Peak running speed (10.7 ± 0.9 cf. 12.1 ± 1.3 km·h -1 ) and respiratory exchange ratio (1.04 ± 0.05 cf. 0.92 ± 0.05) were however different between tests (P<.001). Although similar peak physiological values were revealed between GXT&#95;C and the corresponding verification test (P>.05), VO 2 peak (53.3 ± 7.3 mL·kg -1 ·min -1 ) and heart rate (197 ± 13 b·min -1 ) were significantly lower in the GXT&#95;D verification test (P<.05). In conclusion, a discontinuous GXT is an accurate measure of VO 2 peak in children aged 8 to 10 years and may be a valid alternative to a continuous GXT, despite its longer duration., Competing Interests: the authors declared no conflict of interests regarding the publication of this manuscript.

This study sought to identify any differences in peak muscle activation (EMGPEAK) or average rectified variable muscle activation (EMGARV) during supinated grip, pronated grip, neutral grip and rope pull-up exercises. Nineteen strength trained males (24.9±5y; 1.78±0.74m; 81.3±11.3kg; 22.7±2.5kgm -2 ) volunteered to participate in the study. Surface electromyography (EMG) was collected from eight shoulder-arm-forearm complex muscles. All muscle activation was expressed as a percentage of maximum voluntary isometric contraction (%MVIC). Over a full repetition, the pronated grip resulted in significantly greater EMGPEAK (60.1±22.5vs. 37.1±13.1%MVIC; P=0.004; Effect Size [ES; Cohen's d]=1.19) and EMGARV (48.0±21.2vs. 27.4±10.7%MVIC; P=0.001; ES=1.29) of the middle trapezius when compared to the neutral grip pull-up. The concentric phases of each pull-up variation resulted in significantly greater EMGARV of the brachioradialis, biceps brachii, and pectoralis major in comparison to the eccentric phases (P=<0.01). Results indicate that EMGPEAK and EMGARV of the shoulder-arm-forearm complex during complete repetitions of pull-up variants are similar despite varying hand orientations; however, differences exist between concentric and eccentric phases of each pull-up., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This article sets out to establish the naturalistic study of online social communication as a substantive topic in social psychology and to discuss the challenges of developing methods for a formal analysis of the structural and interactional features of message threads on discussion forums. I begin by outlining the essential features of online communication and specifically discussion forum data, and the important ways in which they depart from spoken conversation. I describe the handful of attempts to devise systematic analytic techniques for adapting methods such as conversation and discourse analysis to the study of online discussion. I then present a case study of a thread from the popular UK parenting forum Mumsnet which presents a number of challenges for existing methods, and examine some of the interactive phenomena typical of forums. Finally, I consider ways in which membership categorization analysis and social identity theory can complement one another in the exploration of both group processes and the rhetorical deployment of identities as dynamic phenomena in online discussion., (© 2016 The British Psychological Society.)

Background: Although many medical educators now undertake formal courses in education, some to a high academic level, there has been little investigation into the ways in which their clinical and educational roles interact. In this qualitative study, we investigate these links and consider their importance., Methods: We carried out semi-structured interviews with 18 medical educators from a variety of backgrounds and specialties to investigate the links between clinical and educational roles. Data were analysed for recurring themes., Findings: We found an intuitive sharing of professional skills between the clinical and educational roles of doctors. Doctors came to see their practice as more complex and nuanced through their teaching, giving them a route to deepen their understanding of their own professional practice and enhance their self-worth. When teaching, doctors drew upon clinical experience, particularly their communication and problem-solving skills, to develop their practice in a holistic way. We found an intuitive sharing of professional skills between the clinical and educational roles of doctors, Discussion: We have found that medical practitioners bring their experience and expertise in clinical medicine to their work as educators. In addition, developing as a medical educator affects and enhances clinical practice. These findings have important implications for those charged with the development of medical education and medical educators themselves, as well as the patients that they care for., (© 2015 John Wiley & Sons Ltd.)

Background: Monitoring central hemodynamic responses to an orthostatic challenge may provide important insight into autonomic nervous system function. Oscillometric pulse wave analysis devices have recently emerged, presenting clinically viable options for investigating central hemodynamic properties. The purpose of the current study was to determine whether oscillometric pulse wave analysis can be used to reliably (between-day) assess central blood pressure and central pressure augmentation (augmentation index) responses to a 5 min orthostatic challenge (modified tilt-table)., Methods: Twenty healthy adults (26.4 y (SD 5.2), 55% F, 24.7 kg/m(2) (SD 3.8)) were tested on 3 different mornings in the fasted state, separated by a maximum of 7 days. Central hemodynamic variables were assessed on the left arm using an oscillometric device., Results: Repeated measures analysis of variance indicated a significant main effect of the modified tilt-table for all central hemodynamic variables (P < 0.001). In response to the tilt, central diastolic pressure increased by 4.5 mmHg (CI: 2.6, 6.4), central systolic blood pressure increased by 2.3 (CI: 4.4, 0.16) mmHg, and augmentation index decreased by an absolute - 5.3%, (CI: -2.7, -7.9%). The intra-class correlation coefficient values for central diastolic pressure (0.83-0.86), central systolic blood pressure (0.80-0.87) and AIx (0.79-0.82) were above the 0.75 criterion in both the supine and tilted positions, indicating excellent between-day reliability., Conclusion: Central hemodynamic responses to an orthostatic challenge can be assessed with acceptable between-day reliability using oscillometric pulse wave analysis., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Social psychologists have become increasingly concerned with examining the ways in which social practices are interrelated with their location. Critical perspectives have highlighted the traditional lack of attention given to both the collective aspects of spatial identities, together with the discursive practices that construct the relationships between people and places. In this article, we draw together the developing discursive work on place with work on children's geographies, in order to examine young people's accounts of spatial regulation. Adopting a discursive approach to the analysis of focus group discussion, we illustrate a variety of concerns managed in relation to spatial practices by 41 young people living in a large city in the South of England. Our findings suggest that everyday use of public space by young people is constructed at a nexus of competing concerns around childhood/adulthood, freedom, and citizenship, and illustrate the dynamic nature of place, and its regulation, as a resource for constructing identities., (© 2013 The British Psychological Society.)

The aim of this exploratory study was to capture and identify changes in clinical thinking amongst foundation trainees after a four-month attachment in general practice, and to develop a means of analysing the data collected to inform understanding about how clinical thinking develops and changes for a trainee - the learner - in the context of clinical experience. We use the term 'clinical thinking' consistently throughout our paper to refer to the trainees' general thinking about a case, and do so in the same way as other academics. Through the innovative use of Mind Maps, we have sought to demonstrate whether there was a significant change in the themes and key features contained in maps drawn by foundation year 2 trainees before and after an attachment in general practice, and to locate the nature of the change if present. Being able to identify such change is potentially valuable as it can assist in revealing a trainee's learning needs and shape future learning.