Perceived thickness and creaminess modulates the short-term satiating effects of high protein drinks

Previous research suggests that increasing beverage protein content enhances subsequent satiety, but whether this effect is entirely attributable to post-ingestive effects of protein or is partly caused by the distinct sensory characteristics imparted by the presence of protein remains unclear. To try and discriminate nutritive from sensory effects of added protein, we contrasted effects of three higher energy (c. 1.2MJ) and one lower energy (LE: 0.35MJ) drink preloads on subsequent appetite and lunch intake. Two higher energy drinks had 44% of energy from protein, one with the sensory characteristics of a juice drink (HP-) and the second thicker and more creamy (HP+). The high-carbohydrate preload (HC+) was matched for thickness and creaminess to the HP+ drink. Participants (healthy male volunteers, n=26) consumed significantly less at lunch after the HP+ (566g) and HC+ (572g) than after HP- (623g) and LE (668g) drinks, although the compensation for drink energy accounted for only 50% of extra energy at best. Appetite ratings indicated that participants felt significantly less hungry and more full immediately before lunch in HP+ and HC+ compared to LE, with HP- intermediate. The finding that protein generated stronger satiety in the context of a thicker creamier drink (HP+ but not HP-), and that an isoenergetic carbohydrate drink (HC+) matched in thickness and creaminess to the HP+ drink generated the same pattern of satiety as HP+ both suggest an important role for these sensory cues in the development of protein-based satiety

The redesign and re-evaluation of an internet-based telerehabilitation system for the assessment of dysarthria in adults

A previous study revealed that reliable assessment of dysarthria was feasible. However, that study also revealed a number of system limitations and suggested that technological enhancements and improvements in study design and clinical assessment protocols were needed before validity and reliability of assessment of dysarthria via telerehabilitation could be confirmed. In the current study, improvements in technology, study design, and clinical assessment protocols were implemented in order to re-examine the validity and reliability of assessing and diagnosing dysarthria via the telerehabilitation medium. The aim of this study was to explore the validity and reliability of assessing dysarthria using both formal standardized and informal assessments via a purpose-built telerehabilitation system. Twenty-four participants with an acquired dysarthria were assessed simultaneously via telerehabilitation and face-to-face (FTF) on a battery of assessments. A custom-built telerehabilitation system enabled real-time telerehabilitation assessment over a 128 Kbps Internet connection. Data analysis included an analysis of strength of agreement between the two methods using percentage agreement and weighted Κ statistics. Inter-rater and intrarater reliability were also examined for both the FTF and telerehabilitation-led assessments. Good strength of agreement was found between the FTF and telerehabilitation assessment methods. High intrarater and inter-rater reliability within both the FTF and telerehabilitation assessment methods supported these findings. Participants reported high overall satisfaction in the telerehabilitation environment. This study describes the improvements made to the telerehabilitation system reported previously and confirms that valid and reliable assessment of dysarthria using both standardized and informal assessments over the Internet is possible using this system

An Investigation of the Standardised Patient Interview Rating Scale (SPIRS) for the Assessment of Speech Pathology Students in a Simulation Clinic

Standardised patients (SPs) are increasingly utilised in health sciences education to assist students in the development of clinical competencies, including interviewing skills. This study investigated the development and validation of a rating scale for formative assessment of speech pathology students in an interview with an SP. Participants in this study were 76 undergraduate speech pathology students and 10 clinical educators who participated in a simulated clinic module. As part of the module, pairs of students interviewed an SP portraying a parent of a child with speech delay. The Standardised Patient Interview Rating Scale (SPIRS) was developed to assess students’ foundation clinical competencies of communication, interviewing and professional practice skills. Students’ interviews were videotaped, rated individually on the SPIRS by the clinical educator, and later re-rated by an expert rater. Data were analysed to determine the content validity, internal consistency, and inter-rater reliability of the tool. In addition, descriptive statistics were used to report student performance levels. Results indicated that the SPIRS had good content validity and internal consistency but that there may be some redundancy in individual items. An acceptable level of inter-rater reliability was achieved. Students generally scored highly, with non-verbal communication being the easiest and professional practice the most difficult skill to demonstrate. The SPIRS was found to be an appropriate tool for formative assessment of students in this simulated clinic module. Recommendations for improving its reliability were made. Further research is required to investigate use of the SPIRS as an assessment tool in other contexts utilising standardised patients

Access to breast prostheses via a government-funded service in Victoria, Australia

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast pros-thesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government\u27s Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision. <br /

Predictors of benefit following pulmonary rehabilitation for interstitial lung disease

SummaryBackgroundPulmonary rehabilitation improves functional capacity and symptoms in the interstitial lung diseases (ILDs), however there is marked variation in outcomes between individuals. The aim of this study was to establish the impact of the aetiology and severity of ILD on response to pulmonary rehabilitation.MethodsForty-four subjects with ILD, including 25 with idiopathic pulmonary fibrosis (IPF), underwent eight weeks of pulmonary rehabilitation. Relationships between disease aetiology, markers of disease severity and response to pulmonary rehabilitation were assessed after eight weeks and six months, regardless of program completion.ResultsIn IPF, greater improvements in 6-minute walk distance (6MWD) immediately following pulmonary rehabilitation were associated with larger forced vital capacity (r = 0.49, p = 0.01), less exercise-induced oxyhaemoglobin desaturation (rS = 0.43, p = 0.04) and lower right ventricular systolic pressure (r = −0.47, p = 0.1). In participants with other ILDs there was no relationship between change in 6MWD and baseline variables. Less exercise-induced oxyhaemoglobin desaturation at baseline independently predicted a larger improvement in 6MWD at six month follow-up. Fewer participants with IPF had clinically important reductions in dyspnoea at six months compared to those with other ILDs (25% vs 56%, p = 0.04). More severe dyspnoea at baseline and diagnosis other than IPF predicted greater improvement in dyspnoea at six months.ConclusionsPatients with IPF attain greater and more sustained benefits from pulmonary rehabilitation when disease is mild, whereas those with other ILDs achieve benefits regardless of disease severity. Early referral to pulmonary rehabilitation should be considered in IPF

Assessment of student competency in a simulated speech-language pathology clinical placement

“This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Speech-Language Pathology on 30 August 2013, available online: http://wwww.tandfonline.com/10.3109/17549507.2013.809603.” http://dx.doi.org/10.3109/17549507.2013.809603.Clinical education programs in speech-language pathology enable the transition of students’ knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students’ performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS®: Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students’ performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements

Computer Literacy and Health Locus of Control as Determinants for Readiness and Acceptability of Telepractice in a Head and Neck Cancer Population

Understanding end-user populations is required in designing telepractice applications. This study explored computer literacy and health locus of control in head/neck cancer (HNC) patients to inform suitability for telerehabilitation. Sixty individuals with oropharygneal cancer were recruited. Computer literacy was examined using a 10-question survey. The Multidimensional Health Locus of Control Scale Form C (MHLC-C) examined perceptions of health “control”.  Participants were mostly middle-aged males, from high socioeconomic backgrounds. Only 10% were non-computer users. Of the computers users, 91% reported daily use, 66% used multiple devices and over 75% rated themselves as “confident” users. More than half were open to using technology for health-related activities. High internal scores (MHLC-C) signified a belief that own behaviour influenced health status.  HNC patients have high computer literacy and an internal health locus of control, both are positive factors to support telepractice models of care. This may include asynchronous models requiring heightened capacity for self-management

Hyperoxia Causes Mitochondrial Fragmentation in Pulmonary Endothelial Cells by Increasing Expression of Pro-Fission Proteins

Objective—We explored mechanisms that alter mitochondrial structure and function in pulmonary endothelial cells (PEC) function after hyperoxia. Approach and Results—Mitochondrial structures of PECs exposed to hyperoxia or normoxia were visualized and mitochondrial fragmentation quantified. Expression of pro-fission or fusion proteins or autophagy-related proteins were assessed by Western blot. Mitochondrial oxidative state was determined using mito-roGFP. Tetramethylrhodamine methyl ester estimated mitochondrial polarization in treatment groups. The role of mitochondrially derived reactive oxygen species in mt-fragmentation was investigated with mito-TEMPOL and mitochondrial DNA (mtDNA) damage studied by using ENDO III (mt-tat-endonuclease III), a protein that repairs mDNA damage. Drp-1 (dynamin-related protein 1) was overexpressed or silenced to test the role of this protein in cell survival or transwell resistance. Hyperoxia increased fragmentation of PEC mitochondria in a time-dependent manner through 48 hours of exposure. Hyperoxic PECs exhibited increased phosphorylation of Drp-1 (serine 616), decreases in Mfn1 (mitofusion protein 1), but increases in OPA-1 (optic atrophy 1). Pro-autophagy proteins p62 (LC3 adapter–binding protein SQSTM1/p62), PINK-1 (PTEN-induced putative kinase 1), and LC3B (microtubule-associated protein 1A/1B-light chain 3) were increased. Returning cells to normoxia for 24 hours reversed the increased mt-fragmentation and changes in expression of pro-fission proteins. Hyperoxia-induced changes in mitochondrial structure or cell survival were mitigated by antioxidants mito-TEMPOL, Drp-1 silencing, or inhibition or protection by the mitochondrial endonuclease ENDO III. Hyperoxia induced oxidation and mitochondrial depolarization and impaired transwell resistance. Decrease in resistance was mitigated by mito-TEMPOL or ENDO III and reproduced by overexpression of Drp-1. Conclusions—Because hyperoxia evoked mt-fragmentation, cell survival and transwell resistance are prevented by ENDO III and mito-TEMPOL and Drp-1 silencing, and these data link hyperoxia-induced mt-DNA damage, Drp-1 expression, mt-fragmentation, and PEC dysfunction

Clinicians' Perspectives of a Novel Home-based Multidisciplinary Telehealth Service for Patients with Chronic Spinal Pain

Chronic spinal pain conditions can often be successfully managed by a non-surgical, multidisciplinary approach, however many individuals are unable to access such specialised services within their local community. A possible solution may be the delivery of care via telerehabilitation. This study aimed to evaluate clinicians’ perspectives on providing clinical care via telerehabilitation during the early implementation of a novel spinal telerehabilitation service.  Eight clinicians’ were recruited, completing surveys at four separate time points. Confidence in providing treatment via telerehabilitation significantly improved with time (?2(3)=16.22, p=0.001). Clinicians became significantly more accepting of telerehabilitation being a time- (?2(3)=11.237, p=0.011), and cost-effective (?2(3)=9.466, p=0.024) platform in which they could deliver care. Overall satisfaction was high, with technology becoming easier to use (p=0.026) and ability to establish rapport significantly improved with experience (p=0.043). Understanding clinicians’ perspectives throughout the early implementation phase of a new telerehabilitation service is a critical component in determining long-term sustainability.