Muscle strengthening intervention for boys with haemophilia: Developing and evaluating a best-practice exercise programme with boys, families and health-care professionals

Background: Muscle strengthening exercises have the potential to improve outcomes for boys with haemophilia, but it is unclear what types of exercise might be of benefit. We elicited the views of health-care professionals, boys and their families to create and assess a home-based muscle strengthening programme. Objective: To design and develop a muscle strengthening programme with healthcare professionals aimed at improving musculoskeletal health, and refine the intervention by engaging boys with haemophilia and their families (Study 1). Following delivery, qualitatively evaluate the feasibility and acceptability of the exercise programme with the boys and the study's physiotherapists (Study 2). Design: A person-based approach was used for planning and designing the exercise programme, and evaluating it post-delivery. The following methods were utilized: modified nominal group technique (NGT) with health-care professionals; focus group with families; exit interviews with boys; and interviews with the study's physiotherapists. Results: Themes identified to design and develop the intervention included exercises to lower limb and foot, dosage, age accommodating, location, supervision and monitoring and incentivization. Programme refinements were carried out following engagement with the boys and families who commented on: dosage, location, supervision and incentivization. Following delivery, the boys and physiotherapists commented on progression and adaptation, physiotherapist contact, goal-setting, creating routines and identifying suitable timeframes, and a repeated theme of incentivization. Conclusions: An exercise intervention was designed and refined through engagement with boys and their families. Boys and physiotherapists involved in the intervention's delivery were consulted who found the exercises to be generally acceptable with some minor refinements necessary

Eating Disorders and the Intestinal Microbiota: Mechanisms of Energy Homeostasis and Behavioral Influence

Purpose of Review: We reviewed and evaluated recently published scientific studies that explored the role of the intestinal microbiota in eating disorders. Recent Findings: Studies have demonstrated that the intestinal microbiota is a contributing factor to both host energy homeostasis and behavior—two traits commonly disrupted in patients with eating disorders. To date, intestinal microbiota research in eating disorders has focused solely on anorexia nervosa (AN). Initial studies have reported an atypical intestinal microbial composition in patients with AN compared to healthy controls. However, the impact of these AN-associated microbial communities on host metabolism and behavior remains unknown. Summary: The intriguing pattern of findings in patients with AN encourages further investigation of the intestinal microbiota in eating disorders. Elucidating the specific role(s) of these microbial communities may yield novel ideas for augmenting current clinical therapies to promote weight gain, decrease gastrointestinal distress, and even reduce psychological symptomatology

A qualitative study of manufacturers' submissions to the UK NICE single technology appraisal process

OBJECTIVES: As part of the National Institute for Health and Clinical Excellence (NICE) Single Technology Appraisal (STA) process, manufacturers present submissions outlining the clinical and cost-effectiveness of new technologies. These submissions are critically appraised by Evidence Review Groups (ERGs), who produce a report, which forms part of the evidence considered by the NICE Appraisal Committees. The purpose of this research was first to identify common issues and concerns identified by the ERGs in their analyses of manufacturers' submissions (MS). The aim was then to use these as a basis to develop feedback for manufacturers. DESIGN: A qualitative study using a content analysis approach to examine two sources of evidence, the first 30 ERG reports and 21 clarification letters associated with these STAs. SETTING: UK HTA programme. PRIMARY AND SECONDARY OUTCOME MEASURES: Common issues and concerns in MS. RESULTS: There were positive comments regarding the quality of the MS, many of which were clearly written. The majority, however, were generally of poor quality and issues and concerns identified across the ERG reports and clarification letters included: criticisms related to the data being used especially data employed in the cost-effectiveness model, failure to perform a necessary analysis and poor reporting of processes used in the MS. Aspects of the decision problem were also often poorly or inadequately addressed by manufacturers. The majority of points raised for clarification related to the economic data analysis. Internal inconsistencies between the clinical and economic sections of the submission were frequently highlighted. These were used as the basis for the development of 12 suggestions for manufacturers. CONCLUSIONS: Much can be done to improve the quality of MS in the NICE STA process. Suggestions include the need for clear and transparent reporting of methods and analyses

Daily Changes in Composition and Diversity of the Intestinal Microbiota in Patients with Anorexia Nervosa: A Series of Three Cases

Anorexia nervosa, a severe psychiatric illness, is associated with an intestinal microbial dysbiosis. Individual microbial signatures dominate in healthy samples, even over time and under controlled conditions, but whether microbial markers of the disorder overcome inter-individual variation during the acute stage of illness or renourishment is unknown. We characterized daily changes in the intestinal microbiota in three acutely ill patients with anorexia nervosa over the entire course of hospital-based renourishment and found significant, patient-specific changes in microbial composition and diversity. This preliminary case series suggests that even in a state of pathology, individual microbial signatures persist in accounting for the majority of intestinal microbial variation

Exact Differential and Corrected Area Law for Stationary Black Holes in Tunneling Method

We give a new and conceptually simple approach to obtain the first law of black hole thermodynamics from a basic thermodynamical property that entropy (S) for any stationary black hole is a state function implying that dS must be an exact differential. Using this property we obtain some conditions which are analogous to Maxwell's relations in ordinary thermodynamics. From these conditions we are able to explicitly calculate the semiclassical Bekenstein-Hawking entropy, considering the most general metric represented by the Kerr-Newman spacetime. We extend our method to find the corrected entropy of stationary black holes in (3+1) dimensions. For that we first calculate the corrected Hawking temperature considering both scalar particle and fermion tunneling beyond the semiclassical approximation. Using this corrected Hawking temperature we compute the corrected entropy, based on properties of exact differentials. The connection of the coefficient of the leading (logarithmic) correction with the trace anomaly of the stress tensor is established . We explicitly calculate this coefficient for stationary black holes with various metrics, emphasising the role of Komar integrals.Comment: references added, typos corrected, LaTeX, 28 pages, no figures, to appear in JHE

Adiabatic following criterion, estimation of the nonadiabatic excitation fraction and quantum jumps

An accurate theory describing adiabatic following of the dark, nonabsorbing state in the three-level system is developed. An analytical solution for the wave function of the particle experiencing Raman excitation is found as an expansion in terms of the time varying nonadiabatic perturbation parameter. The solution can be presented as a sum of adiabatic and nonadiabatic parts. Both are estimated quantitatively. It is shown that the limiting value to which the amplitude of the nonadiabatic part tends is equal to the Fourier component of the nonadiabatic perturbation parameter taken at the Rabi frequency of the Raman excitation. The time scale of the variation of both parts is found. While the adiabatic part of the solution varies slowly and follows the change of the nonadiabatic perturbation parameter, the nonadiabatic part appears almost instantly, revealing a jumpwise transition between the dark and bright states. This jump happens when the nonadiabatic perturbation parameter takes its maximum value.Comment: 33 pages, 8 figures, submitted to PRA on 28 Oct. 200

Humpback whale (Megaptera novaeangliae) distribution and movements in the vicinity of South Georgia and the South Sandwich Islands Marine Protected Area

Humpback whales (Megaptera novaeangliae) are showing strong recovery from commercial whaling in the western South Atlantic. In this region, humpback whales migrate annually from their winter breeding grounds off the coast of Brazil to their summer feeding grounds near to the Polar Front, an area that includes the waters of South Georgia and the South Sandwich Islands (SGSSI). This latter region includes a Marine Protected Area (MPA), which has been developed to ensure sustainable management of fisheries, and protection of foraging predators. To date, management measures within the MPA have primarily been concerned with foraging predators that rely upon Antarctic krill, including for a number of previously over-exploited species. This includes the regional humpback whale population now in recovery in the western South Atlantic. With humpback whales increasing, understanding their spatiotemporal distribution within the MPA is important as it will help inform management particularly in respect of interactions between humpback whales and the regional fishery for Antarctic krill. Here we develop habitat models from the distribution and movement patterns of 16 individuals at their high-latitude feeding grounds, south of 50°S. We show that whale habitat use varies throughout the foraging period. Upon reaching their feeding ground, whales use the area to the east of the South Sandwich Islands, moving westward into the centre of the Scotia Arc and towards South Georgia during the high summer, and then expanding back towards the east in the winter. Based on these findings, we discuss the implications for the future, including necessary research required for underpinning management

Interstellar MHD Turbulence and Star Formation

This chapter reviews the nature of turbulence in the Galactic interstellar medium (ISM) and its connections to the star formation (SF) process. The ISM is turbulent, magnetized, self-gravitating, and is subject to heating and cooling processes that control its thermodynamic behavior. The turbulence in the warm and hot ionized components of the ISM appears to be trans- or subsonic, and thus to behave nearly incompressibly. However, the neutral warm and cold components are highly compressible, as a consequence of both thermal instability in the atomic gas and of moderately-to-strongly supersonic motions in the roughly isothermal cold atomic and molecular components. Within this context, we discuss: i) the production and statistical distribution of turbulent density fluctuations in both isothermal and polytropic media; ii) the nature of the clumps produced by thermal instability, noting that, contrary to classical ideas, they in general accrete mass from their environment; iii) the density-magnetic field correlation (or lack thereof) in turbulent density fluctuations, as a consequence of the superposition of the different wave modes in the turbulent flow; iv) the evolution of the mass-to-magnetic flux ratio (MFR) in density fluctuations as they are built up by dynamic compressions; v) the formation of cold, dense clouds aided by thermal instability; vi) the expectation that star-forming molecular clouds are likely to be undergoing global gravitational contraction, rather than being near equilibrium, and vii) the regulation of the star formation rate (SFR) in such gravitationally contracting clouds by stellar feedback which, rather than keeping the clouds from collapsing, evaporates and diperses them while they collapse.Comment: 43 pages. Invited chapter for the book "Magnetic Fields in Diffuse Media", edited by Elisabete de Gouveia dal Pino and Alex Lazarian. Revised as per referee's recommendation