Using the TIDieR checklist to standardize the description of a functional strength training intervention for the upper limb after stroke

Background and Purpose: Published reports of intervention in randomized controlled trials are often poorly described. The Template for Intervention Description and Replication (TIDieR) checklist has been recently developed to improve the reporting of interventions. The aim of this article is to describe a therapy intervention used in the stroke rehabilitation trial, "Clinical Efficacy of Functional Strength Training for Upper Limb Motor Recovery Early After Stroke: Neural Correlates and Prognostic Indicators" (FAST-INdICATE), using TIDieR. Methods: The functional strength training intervention used in the FAST-INdICATE trial was described using TIDieR so that intervention can be replicated by both clinicians, who may implement it in practice, and researchers, who may deliver it in future research. The usefulness of TIDieR in the context of a complex stroke rehabilitation intervention was then discussed. Results and Discussion: The TIDieR checklist provided a systematic way of describing a treatment intervention used in a clinical trial of stroke rehabilitation. Clarification is needed regarding several aspects of the TIDieR checklist, including in which section to report about the development of the intervention in pilot studies, results of feasibility studies; overlap between training and procedures for assessing fidelity; and where to publish supplementary material so that it remains in the public domain. Summary: TIDieR is a systematic way of reporting the intervention delivered in a clinical trial of a complex intervention such as stroke rehabilitation. This approach may also have value for standardizing intervention in clinical practice. Video abstract is available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A131)

Design of a Debridement Device Using Impinging Jets

Chronic wound care is a significant burden on the healthcare system, affecting an estimated three to six million Americans, manifesting as ulcers associated with restricted blood flow, diabetes mellitus, or pressure. Treatment is frequently unsuccessful, with only an estimated 25–50% of venous and diabetic ulcers closing after 20 weeks of treatment. Debridement, the removal of necrotic tissue and foreign materials from the wounds, is a crucial component in the chronic wound care. While there exist many debridement techniques, the search for new and more effective methods is ongoing. The existing methods of debridement include surgical, the industry gold standard, as well as the mechanical, autolytic, enzymatic, and hydrosurgery (VersaJet™). The VersaJet™ uses a single high-speed jet directed parallel to the wound surface to remove soft necrotic tissue. This paper presents the design of a debridement device that uses two narrow, high-speed impinging fluid jets to excise necrotic tissue. The handheld device can be used to remove strips of necrotic tissue of a predetermined width and depth and was tested on samples of simulated slough, the soft necrotic tissue, and eschar, the hard, scablike necrotic tissue. The preliminary tests indicate that the technique removes necrotic tissue quickly and with good control, suggesting that, with further development, the technique may provide a time-saving alternative to surgical debridement. Further testing, however, is required to ensure that the jets do not damage the surrounding healthy tissues and to quantitatively analyze the effectiveness of the technique relative to other debridement strategies

Leadership for health improvement: implementation and evaluation

Purpose The purpose of this paper is to present a co-authored reflection on the health improvement leadership development programme and the key evaluation messages derived from piloting in an English National Health Service region. It highlights the specific attributes of this approach to health improvement leadership development and clarifies health improvement development issues. Design/methodology/approach Appreciative inquiry and soft systems methodology are combined in an evaluation approach designed to capture individual as well as organisation learning and how it impacts on leadership in specific contexts. Findings The evaluation exposes the health improvement leadership needs of a multi-organisation cohort, offers some explanations for successful achievement of learning needs while also exposing of the challenges and paradoxes faced in this endeavour. Originality/value There are limited reported templates of how to develop leadership for health improvement. This paper details a whole systems approach, acknowledging the impact of context on leadership and an approach to evaluating such complex initiatives

Standard Measures are Inadequate to Monitor Pediatric Adherence in a Resource-Limited Setting

This study aims to compare the use and cost of objective and subjective measures of adherence to pediatric antiretroviral treatment in a primary care facility in South Africa. In a 1-month longitudinal study of 53 caregiver-child dyads, pharmacy refill (PR), measurement of returned syrups (RS), caregiver self-report (3DR) and Visual Analogue Scale (VAS) were compared to Medication Event Monitoring System (MEMS). Adherence was 100% for both VAS and 3DR; by PR and RS 100% and 103%, respectively. MEMS showed that 92% of prescribed doses were administered, but only 66% of these within the correct 12-hourly interval. None of the four measures correlated significantly with MEMS. MEMS data suggest that timing of doses is often more deviant from prescribed than expected and should be better addressed when monitoring adherence. Of all, MEMS was by far the most expensive measure. Alternative, cheaper electronic devices need to be more accessible in resource-limited settings

Prion protein in the cerebrospinal fluid of healthy and naturally scrapie-affected sheep

The aim of this study was to characterize the cerebrospinal fluid (CSF) prion protein (PrP) of healthy and naturally scrapie-affected sheep. The soluble form of CSF PrPC immunoblotted with an anti-octarepeat and an anti-C terminus mAb showed two isoforms of approximately 33 and 26 kDa, corresponding to the biglycosylated and unglycosylated isoforms of brain PrPC. Neither the mean concentration nor the electrophoretic profile of CSF PrP differed between healthy and scrapieaffected sheep, whereas a slightly increased resistance of CSF PrP to mild proteolysis by proteinase K was evident in the CSF of scrapie-affected sheep. No difference in susceptibility to proteolysis was observed between the two ARR and VRQ genetic variants of the purified prokaryote recombinant PrP. It was concluded that the physicochemical properties of PrPC in the CSF could be altered during scrapie and that these changes might reflect the physiopathological process of prion disease

INDIAN BASKETRY IN YOSEMITE VALLEY, 19th-20th Century: Gertrude “Cosie” Hutchings Mills, Tourists and the National Park Service

Basketry is the highest art form of Native Americans in California. I will focus on Yosemite Valley starting in the 1850s when Native Americans adapted progressively to contact with miners, settlers, and tourists. As a Research Associate at the Peabody Museum, Andover, Massachusetts, I inventoried the Native American Basket Collection. The unpublished Hutchings Mills Collection, acquired by Gertrude ‘Cosie’ Hutchings in Yosemite prior to 1900, caught my attention. In 1986, the Department of the Interior requested the collection be loaned, exchanged, or purchased as “the single most important assemblage from that period.” The collection did not leave Andover; however, one basket by Dulce, an activist whose signature appears on the Indian Petition of 1891, was published by the Yosemite Museum in 1991. James Mason Hutchings (1824-1902) was among the first settlers to remote Yosemite Valley and opened a hotel. His daughter, Gertrude ‘Cosie’ Hutchings (1867-1956) was born in the Yosemite Village and collected baskets. The Gertrude Hutchings Mills Collection of 53 baskets is significant because she acquired them from “friends and faithful allies of her family. Those from the Mono and Owens River country were packed mule-back across the Sierras to Yosemite by myself.” Some basket makers are identified by name and location; such record keeping was very rare. My timeline for Yosemite will include the following events: Proclamation as a state park, 1864; eviction of the Hutchings family, 1874; designation as a National Park, 1890; and the Indian Petition, 1891. In the 20th century, the National Park promoted non-traditional Indian events and featured demonstrations by basket makers until the Native American were gradually expelled. My presentation will contrast basket makers in contact with Hutchings and the National Park Service

The Life and Works of Laura Ingalls Wilder

A brief biography of Laura Ingalls Wilder

The Cytotoxicity of the Ajoene Analogue BisPMB in WHCO1 Oesophageal Cancer Cells Is Mediated by CHOP/GADD153

Garlic is a food and medicinal plant that has been used in folk medicine since ancient times for its beneficial health effects, which include protection against cancer. Crushed garlic cloves contain an array of small sulfur-rich compounds such as ajoene. Ajoene is able to interfere with biological processes and is cytotoxic to cancer cells in the low micromolar range. BisPMB is a synthetic ajoene analogue that has been shown in our laboratory to have superior cytotoxicity to ajoene. In the current study we have performed a DNA microarray analysis of bisPMB-treated WHCO1 oesophageal cancer cells to identify pathways and processes that are affected by bisPMB. The most significantly enriched biological pathways as assessed by gene ontology, KEGG and ingenuity pathway analysis were those involving protein processing in the endoplasmic reticulum (ER) and the unfolded protein response. In support of these pathways, bisPMB was found to inhibit global protein synthesis and lead to increased levels of ubiquitinated proteins. BisPMB also induced alternate splicing of the transcription factor XBP-1; increased the expression of the ER stress sensor GRP78 and induced expression of the ER stress marker CHOP/GADD153. CHOP expression was found to be central to the cytotoxicity of bisPMB as its silencing with siRNA rendered the cells resistant to bisPMB. The MAPK proteins, JNK and ERK1/2 were activated following bisPMB treatment. However JNK activation was not critical in the cytotoxicity of bisPMB, and ERK1/2 activation was found to play a pro-survival role. Overall the ajoene analogue bisPMB appears to induce cytotoxicity in WHCO1 cells by activating the unfolded protein response through CHOP/GADD153.Peer reviewe