Exploring the beliefs of young people with cerebral palsy and their families about sport and physical activity in relation to paediatric physiotherapy exercise

Background and Purpose Physiotherapy programmes are an important part of therapeutic input for young people with cerebral palsy (YPwCP), but adherence can be problematic. The involvement of physical activities (PA) could be a possible solution, but YPwCP have lower levels of physical leisure participation than their typically developing peers. Method This qualitative study aimed to explore the beliefs of young people with disabilities and their families about PA in relation to physiotherapy programmes. PA was broadly defined to include not only disability sports, but any aerobic exercise and ‘beliefs’ as perceptions, knowledge and attitudes. A purposive sample of participants from the researcher’s physiotherapy service was invited to undertake semi-structured interviews. Inclusion criteria were 8-19 years of age, having a disability, cognitively able and able to understand and express themselves in English. Parents/care givers were included to capture their discrete perspectives and enable reflective discussion about any synergies or differences between their beliefs and those of their children. Data was analysed using Interpretative Phenomenological Analysis (IPA). Results Two YPwCP and their mothers participated. Three main themes arose: • The feelings evoked by PA, in particular feelings of otherness were underpinned by the desire for ‘normal’ participatory experiences alongside typically developing peers. • External factors and others attitudes affect participation in PA, in particular unfavourable judgements and tokenism within mainstream environments contrasted with a normalising acceptance in disability sports settings. • Physiotherapy and PA are different, participants believed that physiotherapy, physiotherapists and medical venues possessed superior quality, legitimacy and potency. Conclusion The study revealed YPwCP and families’ unique beliefs and preferences concerning PA and the status of physiotherapy and physiotherapists within daily life. Physiotherapists should consider the influence of these beliefs when seeking to signpost to PA or enhance longer-term adherence to programmes within a context of reduced clinical contact

Face-to-Face : An exploratory study of how people with aphasia and speakers of English as a second language perceive their interactions with government agencies

Creating communication accessible environments is increasingly recognised as an essential component to facilitating the social inclusion of people with aphasia (a language disorder after brain damage), (Cruice, 2007; Duchan, 2006; Duchan, Jennings, Barrett, & Butler, 2006; Howe, Worrall, & Hickson, 2008 ; Pound, Duchan, Penman, Hewitt, & Parr, 2007; Simmons-Mackie & Damico, 2007). There have been suggestions that communication access principles in aphasia may also assist people with the communication difficulties associated with English as a second language (ESL) (Kagan & LeBlanc, 2002; Law et al., 2010; Worrall, Rose, Howe, McKenna, & Hickson, 2007). Currently, in Western Australia for example, ESL speakers are supported by interpreting and translation services (Government of Western Australia. Office of Multicultural Interests, 2008). However, there appears to be a gap in assisting the collaborative communication strategies which ESL speakers and public service providers naturally use to succeed in their interactions (McPake et al., 2002). Interacting with government agencies is a common experience for many people. However, despite a growing body of evidence of the need for improved communication access, in Australia this knowledge has yet to translate into policies and supporting documents on access and inclusion. For these services to become socially inclusive, a multidimensional approach to communication access needs to be considered. This study explores whether there is any foundation to anecdotal information that communication access principles which support people with aphasia (PWA) also facilitate access and inclusion for ESL speakers. The findings of this study highlight the need for access and inclusion policies to recognise the broad principles of communication access to create environments which are more readily reached by people with reduced communication competency. Aims: This study explored people with aphasia and ESL speakers’ perceptions of their face-to-face interactions with public service providers in Western Australia. The study investigated three principal questions: What features appear to enable communication access? What features appear to constrain communication access? What do participants perceive to be the impact of these encounters? Methodology: Using a sociological conceptual framework based on a social interactionism approach, the study will draw from the theories of Pierre Bourdieu, Erving Goffman and Anthony Giddens to construct an argument to illustrate how communication access is socially situated and can impact on identity construction, resilience, the negotiation of social capital and ultimately, social inclusion

Complete Genome Sequence of the Citrobacter freundii Type Strain.

Citrobacter freundii is a species of facultative anaerobic Gram-negative bacteria of the family Enterobacteriaceae The complete genome is composed of a single chromosomal circle of 4,957,773 bp with a G+C content of 52%

Stimulation of the tibial nerve: a protocol for a multicentred randomised controlled trial for urinary problems associated with Parkinson’s disease—STARTUP

Introduction Parkinson’s disease is the second most common chronic neurodegenerative condition with bladder dysfunction affecting up to 71%. Symptoms affect quality of life and include urgency, frequency, hesitancy, nocturia and incontinence. Addressing urinary dysfunction is one of the top 10 priority research areas identified by the James Lind Alliance and Parkinson’s UK. Objectives Conduct a randomised controlled trial (RCT) targeting people with Parkinson’s disease (PwP) who have self-reported problematic lower urinary tract symptoms, investigating the effectiveness of transcutaneous tibial nerve stimulation (TTNS) compared with sham TTNS. Implement a standardised training approach and package for the correct application of TTNS. Conduct a cost-effectiveness analysis of TTNS compared with sham TTNS. Methods and analysis An RCT of 6 weeks with twice weekly TTNS or sham TTNS. Participants will be recruited in 12 National Health Service neurology/movement disorder services, using a web-based randomisation system, and will be shown how to apply TTNS or sham TTNS. Participants will receive a weekly telephone call from the researchers during the intervention period. The trial has two coprimary outcome measures: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Prostate Symptom Score. Secondary outcomes include a 3-day bladder diary, quality of life, acceptability and fidelity and health economic evaluation. Outcomes will be measured at 0, 6 and 12 weeks. A sample size of 208 randomised in equal numbers to the two arms will provide 90% power to detect a clinically important difference of 2.52 points on the Internatioanl Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and of 3 points in the International Prostate Symptom Score total score at 12 weeks at 5% significance level, based on an SD of 4.7 in each arm and 20% attrition at 6 weeks. Analysis will be by intention to treat and pre defined in a statistical analysis plan Ethics and dissemination East of Scotland Research Ethics Service (EoSRES), 18/ES00042, obtained on 10 May 2018. The trial will allow us to determine effectiveness, safety, cost and acceptability of TTNS for bladder dysfunction in PWP. Results will be published in open access journals; lay reports will be posted to all participants and presented at conferences. Trial registration number ISRCTN12437878; Pre-results

Transient Reactivation of a Deep-Seated Landslide by Undrained Loading Captured With Repeat Airborne and Terrestrial Lidar

Landslides reactivate due to external environmental forcing or internal mass redistribution, but the process is rarely documented quantitatively. We capture the three-dimensional, 1-m resolution surface deformation field of a transiently reactivated landslide with image correlation of repeat airborne lidar. Undrained loading by two debris flows in the landslide’s head, rather than external forcing, triggered reactivation. After that loading, the lower 2 km of the landslide advanced by up to 14 m in 2 years before completely stopping. The displacement field over those 2 years implies that the slip surface gained 1 kPa of shear strength, which was likely accomplished by a negative dilatancy-pore pressure feedback as material deformed around basal roughness elements. Thus, landslide motion can be decoupled from external environmental forcing in cases, motivating the need to better understand internal perturbations to the stress field to predict hazards and sediment fluxes as landscapes evolve

Targeting the use of reminders and notifications for uptake by populations (TURNUP): a systematic review and evidence synthesis.

Background: Missed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects. Objectives: This project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments. Design: Three inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3). Data sources: Database searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics Engineers Xplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3. Methods: We conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptualframework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking. Results: A total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups. Limitations: Generally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings. Conclusions: Simple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches

Multiple Satellite Observations of Cloud Cover in Extratropical Cyclones

Using cloud observations from NASA Moderate Resolution Imaging Spectroradiometer, Multiangle Imaging Spectroradiometer, and CloudSat-CALIPSO, composites of cloud fraction in southern and northern hemisphere extratropical cyclones are obtained for cold and warm seasons between 2006 and 2010, to assess differences between these three data sets, and between summer and winter cyclones. In both hemispheres and seasons, over the open ocean, the cyclone-centered cloud fraction composites agree within 5% across the three data sets, but behind the cold fronts, or over sea ice and land, the differences are much larger. To supplement the data set comparison and learn more about the cyclones, we also examine the differences in cloud fraction between cold and warm season for each data set. The difference in cloud fraction between cold and warm season southern hemisphere cyclones is small for all three data sets, but of the same order of magnitude as the differences between the data sets. The cold-warm season contrast in northern hemisphere cyclone cloud fractions is similar for all three data sets: in the warm sector, the cold season cloud fractions are lower close to the low, but larger on the equator edge than their warm season counterparts. This seasonal contrast in cloud fraction within the cyclones warm sector seems to be related to the seasonal differences in moisture flux within the cyclones. Our analysis suggests that the three different data sets can all be used confidently when studying the warm sector and warm frontal zone of extratropical cyclones but caution should be exerted when studying clouds in the cold sector

Adolescent bullying and sleep difficulties

This study evaluated whether adolescents who report having been bullied, being bullies, or report both being a bully and being bullied experience more sleep difficulties than children uninvolved in bullying. The study drew upon cognitive theories of insomnia, investigating whether the extent to which young people report worrying about bullying can moderate associations between victimization and sleep difficulties. Participants were 5420 adolescents who completed a self-report questionnaire. Pure Victims (OR = 1.72: 95% CI [1.07 – 2.75]), Pure Bullies (OR = 1.80: 95% CI [1.16 – 2.81]), and Bully-Victims (OR = 2.90: 95% CI [1.17 – 4.92]) were all more likely to experience sleep difficulties when compared to uninvolved young people. The extent to which young people reported worrying about being bullied did not moderate the links between victimization and sleep difficulties. In this way, bullying is clearly related to sleep difficulties among adolescents but the conceptual reach of the cognitive model of insomnia in this domain is questioned

Appointment reminder systems are effective but not optimal: results of a systematic review and evidence synthesis employing realist principles

Missed appointments are an avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Healthcare services are increasingly utilizing reminder systems to manage these negative effects. This study explores the effectiveness of reminder systems for promoting attendance, cancellations and rescheduling of appointments across all healthcare settings and for particular patient groups and the contextual factors which indicate that reminders are being employed sub-optimally. We used three inter-related reviews of quantitative and qualitative evidence. Firstly, using pre-existing models and theories, we developed a conceptual framework to inform our understanding of the Contexts and Mechanisms which influence reminder effectiveness. Secondly, we performed a review following Centre for Reviews & Dissemination (CRD) guidelines to investigate the effectiveness of different methods of reminding patients to attend health service appointments. Finally, to supplement the effectiveness information, we completed a review informed by realist principles to identify factors likely to influence non-attendance behaviors and the effectiveness of reminders. We found consistent evidence that all types of reminder systems are effective at improving appointment attendance across a range of health care settings and patient populations. Reminder systems may also increase cancellation and rescheduling of unwanted appointments. “Reminders plus”, which provide additional information beyond the reminder function, may be more effective than simple reminders at reducing non-attendance at appointments in particular circumstances. We identified six areas of inefficiency which indicate that reminder systems are being used sub-optimally. Unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their healthcare appointment. The choice of reminder system should be tailored to the individual service. To optimize appointment and reminder systems, healthcare services need supportive administrative processes to enhance attendance, cancellation, rescheduling and re-allocation of appointments to other patients