Community-based Rehabilitation Training after stroke: Protocol of a pilot randomised controlled trial (ReTrain)

Introduction: The Rehabilitation Training (ReTrain) intervention aims to improve functional mobility, adherence to poststroke exercise guidelines and quality of life for people after stroke. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost-effectiveness of ReTrain, which is based on Action for Rehabilitation from Neurological Injury (ARNI). The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. Methods and analysis: A 2-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed-methods process evaluation and economic evaluation. 48 participants discharged from clinical rehabilitation despite residual physical disability will be individually randomised 1:1 to ReTrain (25 sessions) or control (exercise advice booklet). Outcome assessment at baseline, 6 and 9 months include Rivermead Mobility Index; Timed Up and Go Test; modified Patient-Specific Functional Scale; 7-day accelerometry; Stroke Self-efficacy Questionnaire, exercise diary, Fatigue Assessment Scale, exercise beliefs and self-efficacy questionnaires, SF-12, EQ-5D-5L, Stroke Quality of Life, Carer Burden Index and Service Receipt Inventory. Feasibility, acceptability and process outcomes include recruitment and retention rates; with measurement burden and trial experiences being explored in qualitative interviews (20 participants, 3 intervention providers). Analyses include descriptive statistics, with 95% CI where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. Ethics and dissemination: National Health Service (NHS) National Research Ethics Service approval granted in April 2015; recruitment started in June. Preliminary studies suggested low risk of serious adverse events; however (minor) falls, transitory muscle soreness and high levels of postexercise fatigue are expected. Outputs include pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised Trainer and Intervention Delivery manuals for multicentre replication of ReTrain; presentations at conferences, public involvement events; internationally recognised peer-reviewed journal publications, open access sources and media releases

Physical activity, sleep, and fatigue in community dwelling Stroke Survivors

Stroke can lead to physiological and psychological impairments and impact individuals’ physical activity (PA), fatigue and sleep patterns. We analysed wrist-worn accelerometry data and the Fatigue Assessment Scale from 41 stroke survivors following a physical rehabilitation programme, to examine relationships between PA levels, fatigue and sleep. Validated acceleration thresholds were used to quantify time spent in each PA intensity/sleep category. Stroke survivors performed less moderate to vigorous PA (MVPA) in 10 minute bouts than the National Stroke guidelines recommend. Regression analysis revealed associations at baseline between light PA and fatigue (p = 0.02) and MVPA and sleep efficiency (p = 0.04). Light PA was positively associated with fatigue at 6 months (p = 0.03), whilst sleep efficiency and fatigue were associated at 9 months (p = 0.02). No other effects were shown at baseline, 6 or 9 months. The magnitude of these associations were small and are unlikely to be clinically meaningful. Larger trials need to examine the efficacy and utility of accelerometry to assess PA and sleep in stroke survivorsStroke Association for funding this research (TSA – 2014-03) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trus

Deciphering interplay between Salmonella invasion effectors

Bacterial pathogens have evolved a specialized type III secretion system (T3SS) to translocate virulence effector proteins directly into eukaryotic target cells. Salmonellae deploy effectors that trigger localized actin reorganization to force their own entry into non-phagocytic host cells. Six effectors (SipC, SipA, SopE/2, SopB, SptP) can individually manipulate actin dynamics at the plasma membrane, which acts as a ‘signaling hub’ during Salmonella invasion. The extent of crosstalk between these spatially coincident effectors remains unknown. Here we describe trans and cis binary entry effector interplay (BENEFIT) screens that systematically examine functional associations between effectors following their delivery into the host cell. The results reveal extensive ordered synergistic and antagonistic relationships and their relative potency, and illuminate an unexpectedly sophisticated signaling network evolved through longstanding pathogen–host interaction

Wide Field Photometry of the Galactic Globular Cluster M22

We present wide field photometry of the Galactic Globular Cluster M~22 in the B, V and I passbands for more than 186,000 stars. The study is complemented by the photometry in two narrowband filters centered on H$_{\alpha}$ and the adjacent continuum, and by infrared J, H and K magnitudes derived from the 2 MASS survey for $\sim$2000 stars. Profiting from this huge database, we completely characterized the evolved stellar sequences of the cluster by determining a variety of photometric parameters, including new photometric estimates of the mean metallicity, reddening and distance to the cluster. In particular, from our multi-wavelength analysis, we re-examined the long-standing metallicity spread problem in M~22. According to our dataset, we conclude that most of the observed width of the red giant branch must be due to differential reddening, which amounts to a maximum of $\Delta E(B-V)\simeq0.06$, although the presence of a small metallicity spread cannot be completely ruled out. More specifically, the maximum metallicity spread allowed by our data is of the order of $\Delta$[Fe/H]$\simeq 0.1\div 0.2$ dex, i.e., not much more than what allowed by the photometric errors. Finally, we identified most of the known variable stars and peculiar objects in our field of view. In particular, we find additional evidence supporting previous optical identifications of the central star of the Planetary Nebula IRAS 18333-2357, which is associated with M~22.Comment: 15 pages, 16 figures, accepted for publication in MNRA

When who and how matter: explaining the success of referendums in Europe

This article aims to identify the institutional factors that make a referendum successful. This comparative analysis seeks to explain the success of top-down referendums organized in Europe between 2001 and 2013. It argues and tests for the main effect of three institutional factors (popularity of the initiator, size of parliamentary majority, and political cues during referendum campaigns) and controls for the type of referendum and voter turnout. The analysis uses data collected from referendums and electoral databases, public opinion surveys, and newspaper articles. Results show that referendums proposed by a large parliamentary majority or with clear messages from political parties during campaign are likely to be successful

Resilience in the Face of Disaster: Prevalence and Longitudinal Course of Mental Disorders following Hurricane Ike

Objectives: Natural disasters may increase risk for a broad range of psychiatric disorders, both in the short- and in the medium-term. We sought to determine the prevalence and longitudinal course of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), depression, and suicidality in the first 18 months after Hurricane Ike. Methods: Six hundred fifty-eight adults representative of Galveston and Chambers Counties, Texas participated in a random, population-based survey. The initial assessment was conducted 2 to 5 months after Hurricane Ike struck Galveston Bay on September 13, 2008. Follow-up assessments were conducted at 5 to 9 and 14 to 18 months after Hurricane Ike. Results: Past-month prevalence of any mental disorder (20.6% to 10.9%) and hurricane-related PTSD (6.9% to 2.5%) decreased over time. Past-month prevalence of PTSD related to a non-disaster traumatic event (5.8% to 7.1%), GAD (3.1% to 1.8%), PD (0.8% to 0.7%), depression (5.0% to 5.6%), and suicidality (2.6% to 4.2%) remained relatively stable over time. Conclusions: PTSD, both due to the hurricane and due to other traumatic events, was the most prevalent psychiatric disorder 2 to 5 months after Hurricane Ike. Prevalence of psychiatric disorders declined rapidly over time, suggesting that the vast majority of individuals exposed to this natural disaster ‘bounced back’ and were resilient to long-term mental health consequences of this large-scale traumatic event

The ideal job-seeker norm: unemployment and marital privileges in the professional middle-class

Objective: To understand how heterosexual US married parents interpret and respond to a spouse's unemployment and subsequent job-searching. Background: The pervasiveness of employment uncertainty, and unemployment, may propel families to embrace gender egalitarian norms. Quantitative research finds that this possibility is not borne out. Qualitative research has sought to illuminate mechanisms as to how gender norms persist even during a time that is optimal for dismantling them, but these mechanisms remain unclear. Method: Seventy-two in-depth interviews were conducted with a nonrandom sample of heterosexual, professional, dual-earner, married, unemployed women, men, and their spouses in the United States. Follow-up interviews were conducted with 35 participants. Intensive family observations were conducted with four families, two of unemployed men, and two of unemployed women. Results: Unemployed women, men, and spouses acknowledge that a set of time-intensive activities are key for reemployment (the ideal job-seeker norm). Couples with unemployed men direct resources such as time, space, and even money to facilitate unemployed men's compliance with the ideal job-seeker norm. Couples downplay the importance of women's reemployment and do not direct similar resources to help unemployed women job-search. Conclusion: Couples preserve a traditional gender status quo, often in defiance of material realities, by actively maintaining men's position at the helm of paid work and women's at unpaid work. Implications: Linking unemployment and job-seeking with the institution of heterosexual marriage reveals novel insights into social and marital processes shaping job-seeking

Self-reported diabetes is associated with self-management behaviour: a cohort study

<p>Abstract</p> <p>Background</p> <p>The purposes of this cohort study were to establish how frequently people with physician-diagnosed diabetes self-reported the disease, to determine factors associated with self-reporting of diabetes, and to evaluate subsequent differences in self-management behaviour, health care utilisation and clinical outcomes between people who do and do not report their disease.</p> <p>Methods</p> <p>We used a registry of physician-diagnosed diabetes as a reference standard. We studied respondents to a 2000/01 population-based health survey who were in the registry (n = 1,812), and we determined the proportion who reported having diabetes during the survey. Baseline factors associated with self-report and subsequent behavioural, utilisation and clinical differences between those who did and did not self-report were defined from the survey responses and from linkage with administrative data sources.</p> <p>Results</p> <p>Only 75% of people with physician-diagnosed diabetes reported having the disease. People who did self-report were more likely to be male, to live in rural areas, to have longer disease duration and to have received specialist physician care. People who did not report having diabetes in the survey were markedly less likely to perform capillary blood glucose monitoring in the subsequent two years (OR 0.05, 95% CI 0.02 to 0.08). They were also less likely to receive specialist physician care (OR 0.55, 95% CI 0.37 to 0.86), and were less likely to require hospital care for hypo- or hyperglycaemia (OR 0.09, 95% CI 0.01 to 0.28).</p> <p>Conclusion</p> <p>Many people with physician-diagnosed diabetes do not report having the disease, but most demographic and clinical features do not distinguish these individuals. These individuals are much less likely to perform capillary glucose monitoring, suggesting that their diabetes self-management is inadequate. Clinicians may be able to use the absence of glucose monitoring as a screening tool to identify people needing a detailed evaluation of their disease knowledge.</p

The calibration of the RGB Tip as a Standard Candle: Extension to Near Infrared colors and higher metallicity

New empirical calibrations of the Red Giant Branch Tip in the I,J,H and K bands based on two fundamental pillars, namely omega Centauri and 47 Tucanae, have been obtained by using a large optical and near infrared photometric database. Our best estimates give M_I(TRGB)= -4.05 pm 0.12, M_J(TRGB)= -5.20 pm 0.16, M_H(TRGB)= -5.94 pm 0.18 and M_K(TRGB) = -6.04 pm 0.16 at [M/H]=-1.5 (omega Cen) and M_I(TRGB)= -3.91 pm 0.13, M_J(TRGB)= -5.47 pm 0.25, M_H(TRGB)= -6.35 pm 0.30 and M_K(TRGB)= -6.56 pm 0.20 at [M/H]=-0.6 (47 Tuc). With these new empirical calibrations we also provide robust relations of the TRGB magnitude in I, J, H and K bands as a function of the global metallicity ([M/H]). It has also been shown that our calibrations self-consistently provide a distance modulus of the Large Magellanic Cloud in good agreement with the standard value ((m-M)_0 = 18.50)).Comment: A&A latex, 14 pages, 7 .ps figures (fig. 1 and fig. 3 provided in low resolution version). Accepted by Astronomy & Astrophysics Correction of a typographical error in Fig. 7; M_I vs [M/H] relatio

Gamma-ray flares from the Crab Nebula

A young and energetic pulsar powers the well-known Crab Nebula. Here we describe two separate gamma-ray (photon energy >100 MeV) flares from this source detected by the Large Area Telescope on board the Fermi Gamma-ray Space Telescope. The first flare occurred in February 2009 and lasted approximately 16 days. The second flare was detected in September 2010 and lasted approximately 4 days. During these outbursts the gamma-ray flux from the nebula increased by factors of four and six, respectively. The brevity of the flares implies that the gamma rays were emitted via synchrotron radiation from PeV (10^15 eV) electrons in a region smaller than 1.4 10^-2 pc. These are the highest energy particles that can be associated with a discrete astronomical source, and they pose challenges to particle acceleration theory.Comment: Contact authors: Rolf Buehler,[email protected]; Stefan Funk,[email protected]; Roger Blandford,rdb3@stanford ; 16 pages,2 figure