Development and Psychometric Properties of A Screening Tool for Assessing Developmental Coordination Disorder in Adults

Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder affecting motor coordination. Evidence suggests this disorder persists into adulthood and may be associated with biomechanical dysfunction and pain. We report on the development and initial validation of a questionnaire to assess for DCD in adults. Methods: An initial item pool (13 items) was derived from the American Psychiatric Association criteria and World Health Organisation definition for DCD. An expert panel assessed face and content validity which led to a 9-item Functional Difficulties Questionnaire (FDQ-9) with possible scores ranging from 9-36 (higher scores indicating greater functional difficulties). The FDQ-9 was piloted on individuals recruited from convenience samples. The underlying factor structure and aspects of reliability, validity and accuracy were tested. The Receiver Operating Characteristic Curve was employed to evaluate the diagnostic accuracy of the test using self-reported dyspraxia as the reference standard. Results: Principal Axis Factoring yielded a two factor solution relating to gross and fine motor skills; for conceptual parsimony these were combined. Internal reliability was high (0.81), the mean inter-item correlation was 0.51 and preliminary findings suggested satisfactory construct validity. The Area under the Curve was 0.918 [95% CI 0.84-1.00] indicating a diagnostic test with high accuracy. A cut-off score was established with a sensitivity and specificity of 86% [95% CI 78%-89%] and 81% [95 % CI 73%-89%] respectively. Test-retest reliability was good (ICC 0.96 [95% CI 0.92 to 0.98]. Conclusion: The psychometric properties of the FDQ-9 appear promising. Work is required to conduct further psychometric evaluations on new samples and apply the scale to clinical practice

Facilitating improvements in interprofessional pain management.

Pain is a global phenomenon in which it has been estimated that 20% of adults and 8% of children suffer from at any one time of whom 10% suffer chronic pain [1,2]. Pain is the leading reason for primary care consultations (80%) and musculoskeletal pain is the commonest reason for work absenteeism [3,4]. Pain is complex and there are aspects that require better recognition and understanding in order to improve its treatment and management.</p

Controlling risk in a lightning-speed trading environment

A small group of high-frequency algorithmic trading firms have invested heavily in technology to leverage the nexus of high-speed communications, mathematical advances, trading and high-speed computing. By doing so, they are able to complete trades at lightning speeds. High-frequency algorithmic trading strategies rely on computerized quantitative models that identify which type of financial instruments to buy or sell (e.g., stocks, options or futures), as well as the quantity, price, timing and location of the trades. These so-called black boxes are capable of reading market data, transmitting thousands of order messages per second to an exchange, cancelling and replacing orders based on changing market conditions and capturing price discrepancies with little or no human intervention.Counterfeits and counterfeiting

Association Between Joint Hypermobility Syndrome and Developmental Coordination Disorder – A Review.

Introduction: The term joint hypermobility syndrome (JHS) was adopted after clinicians became aware of the myriad of symptoms associated with this multisystemic condition. JHS is an inherited disorder of connective tissues affecting the musculoskeletal and visceral systems which may contribute to a reduction in health related physical fitness. Pain associated with JHS may be influenced by hypermobility and biomechanical dysfunction. Biomechanical dysfunction observed in patients with JHS may be as a result of impaired motor control and in particular developmental coordination disorder (DCD). DCD (described in the literature utilising the terms clumsy child syndrome; perceptual motor dysfunction; dyspraxia) is a neurodevelopmental condition characterised by coordination difficulties affecting function. The objective of this review is to examine the association between hypermobility, JHS, motor control impairment and DCD. Methods and data sources: EMBASE, MEDLINE, CINAHL, ASSIA, PsychARTICLES, SPORTDiscus and PsycINFO from 1989 - 2009. Research articles written in English and peer reviewed were included. Results: Five research papers were identified. The studies employed a variety of methodologies and assessment tools for reporting joint hypermobility, JHS, motor delay, motor impairments and DCD. All five studies reported on children between the ages of six months and 12 years. Three out of four studies reported on association between impaired motor development, motor delay and joint hypermobility. There was no consensus as to whether motor delay, impaired motor development and joint hypermobility continued as the child matured. One study ascertained that children with JHS reported similar functional difficulties as children with DCD. Conclusion: There was a paucity of literature relating to an association between joint hypermobility, JHS, impaired motor control, motor delay and DCD in children, there was no literature pertaining to adults. This association requires further exploration if professionals are to understand, nurture and manage those reporting these associated conditions

High Prevalence of Hypermobility and Benign Joint Hypermobility Syndrome (BJHS) in Oman

PURPOSE: To ascertain the prevalence of hypermobility and BJHS in a female patient population with musculoskeletal pain and compare the associated features with a pain free control group. RELEVANCE: Hypermobility is linked with increased musculoskeletal signs and symptoms. The existence of hypermobility with pain may indicate the presence of BJHS, which is a heritable connective tissue disorder synonymous with Ehlers-Danlos type III. Hypermobility is known to be race dependant with Asians and Africans being more hypermobile than Caucasians. The fragility of tissues in those with BJHS makes them more vulnerable to pain associated with soft tissue overuse injuries, traumatic synovitis, sprains and recurrent shoulder dislocations (Grahame 2000; Grahame et al 1981; Finterbush and Pogund 1982) it is also associated with delayed tissue healing, impaired proprioception (Mallik et al 1994; Hall et al 1995) and chronic pain. (Harding and Grahame 1990) PARTICIPANTS: 94 Female Omani patients with musculoskeletal pain attending the rehabilitation department outpatient clinics of the Khoula Hospital aged 18–50 were examined. 90 controls of the same age were recruited from the female Omani hospital staff. METHODS: All patients and controls were examined and questioned by one physiotherapist (CC), who had received training from a rheumatologist (RG) in clinical examination of patients at the hypermobility clinic, University College Hospital, London. Patients and controls were examined using the Beighton score and Brighton Criteria. ANALYSIS: Analysis was by χ2 for number of individuals and t-test for joint mobility scores. (Excel® 2002) RESULTS: 51% of patients were found to be hypermobile as opposed to 30% of controls (p = 0.015). 55.3% of patients had features of BJHS as opposed to 21.1% of controls. (p ≤ 0.0001). Significantly more patients presenting with knee pain had BJHS (p = 0.02). There was a non-significant trend for patients with BJHS to re-attend the out patient clinics (p= 0.06). CONCLUSIONS: This study established that this patient population was significantly more hypermobile than a control population. The incidence of BJHS in patients in this study was higher than that noted amongst female Caucasians, but similar to non Caucasians attending rheumatological clinics in the UK. (Grahame and Hakim 2004). Further epidemiological studies are required in other populations to look at patient re-attendance in musculoskeletal clinics and more specifically for those presenting with back and knee pain. IMPLICATIONS: Better recognition and awareness of hypermobility and BJHS will enable patients to receive treatment programmes, modified to take into account tissue fragility, hypermobile joints, impaired proprioception and chronic pain. KEYWORDS: Hypermobility, Pain, Joints. FUNDING ACKNOWLEDGEMENTS: No funding. Jane Simmonds, UCL supervising team, Professor R. Grahame and Dr. A. Hakim from the Hypermobility clinic UCH, London, Professor H. Holmberg, Khoula Hospital Director, Samia Al Marjeby head of rehabilitation, the staff and patients of Khoula Hospital, Muscat, Oman. CONTACT: [email protected] ETHICS COMMITTEE: Khoula Hospital Ethics committee, Khoula Hospital, Muscat, Oman (12/11/2003

Cultural challenges to secondary prevention: Implications for Saudi women

Like other highly developed countries, cardiovascular disease (CVD) and coronary heart disease (CHD) are major health problems in Saudi Arabia. The aetiology of cardiovascular disease (CVD) burden within the Saudi population is similar to Western countries with atherosclerosis, hypertension, ischemic heart disease and diabetes highly prevalent with the main risk factors being smoking, obesity and inactivity. There are differences between Saudi men and women in epidemiology, risk factors and health service provision for CHD. These sex and gender based factors are important in considering the health and well-being of Saudi women. Currently, there is limited focus on the cardiovascular health of Saudi women. The aim of this paper is to examine culturally specific issues for Saudi women and the implications for secondary prevention

Thomas Moran\u27s West: Chromolithography, High Art, and Popular Taste

Review of: Thomas Moran\u27s West: Chromolithography, High Art, and Popular Taste, by Joni L. Kinsey

'My grandmother told me the story about...': Folklore in a Secondary Short Story Unit

Communication

Leadership Matters: Building Leadership Capacity

Explores strategies that school administrators employ in schools where student learning has improved. Outlines the key conditions for accelerating student achievement, and provides criteria for determining the quality of project-based learning

Making Community-Based Research Work: Lessons Learned from a Liberal Arts College

Trinity College launched the Community Learning Research Fellows Program in 2011 to support undergraduate community-based research (CBR). Our goal was to create an environment that supports high-quality undergraduate research consistent with the principles of community learning. Our strategy focused on building the right type of collaborative relationships among the different actors involved in CBR. We learned three important lessons in our efforts to support these relationships: (1) The community perspective must be integrated into the structure of the program to lend it authority; (2) Peer learning should be used to better prepare students to meet the challenges of CBR; and (3) Expanding the collaborative learning model to include a diverse group of participants empowers students to construct knowledge with and for their community partners. The broader implications of these lessons are discussed in the conclusion