Focus on Function – a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy

<p>Abstract</p> <p>Background</p> <p>Children with cerebral palsy receive a variety of long-term physical and occupational therapy interventions to facilitate development and to enhance functional independence in movement, self-care, play, school activities and leisure. Considerable human and financial resources are directed at the "intervention" of the problems of cerebral palsy, although the available evidence supporting current interventions is inconclusive. A considerable degree of uncertainty remains about the appropriate therapeutic approaches to manage the habilitation of children with cerebral palsy. The primary objective of this project is to conduct a multi-site randomized clinical trial to evaluate the efficacy of a task/context-focused approach compared to a child-focused remediation approach in improving performance of functional tasks and mobility, increasing participation in everyday activities, and improving quality of life in children 12 months to 5 years of age who have cerebral palsy.</p> <p>Method/Design</p> <p>A multi-centred randomized controlled trial research design will be used. Children will be recruited from a representative sample of children attending publicly-funded regional children's rehabilitation centers serving children with disabilities in Ontario and Alberta in Canada. Target sample size is 220 children with cerebral palsy aged 12 months to 5 years at recruitment date. Therapists are randomly assigned to deliver either a context-focused approach or a child-focused approach. Children follow their therapist into their treatment arm. Outcomes will be evaluated at baseline, after 6 months of treatment and at a 3-month follow-up period. Outcomes represent the components of the International Classification of Functioning, Disability and Health, including body function and structure (range of motion), activities (performance of functional tasks, motor function), participation (involvement in formal and informal activities), and environment (parent perceptions of care, parental empowerment).</p> <p>Discussion</p> <p>This paper presents the background information, design and protocol for a randomized controlled trial comparing a task/context-focused approach to a child-focused remediation approach in improving functional outcomes for young children with cerebral palsy.</p> <p>Trial registration</p> <p>[clinical trial registration #: NCT00469872]</p

Quantifying system disturbance and recovery from historical mining-derived metal contamination at Brotherswater, northwest England

The final publication is available at Springer via https://doi.org/10.1007/s10933-016-9907-1Metal ore extraction in historical times has left a legacy of severe contamination in aquatic ecosystems around the world. In the UK, there are ongoing nationwide surveys of present-day pollution discharged from abandoned mines but few assessments of the magnitude of contamination and impacts that arose during historical metal mining have been made. We report one of the first multi-centennial records of lead (Pb), zinc (Zn) and copper (Cu) fluxes into a lake (Brotherswater, northwest England) from point-sources in its catchment (Hartsop Hall Mine and Hogget Gill processing plant) and calculate basin-scale inventories of those metals. The pre-mining baseline for metal contamination has been established using sediment cores spanning the past 1,500 years and contemporary material obtained through sediment trapping. These data enabled the impact of 250 years of local, small-scale mining (1696 – 1942) to be quantified and an assessment of the trajectory towards system recovery to be made. The geochemical stratigraphy displayed in twelve sediment cores show strong correspondence to the documented history of metal mining and processing in the catchment. The initial onset in 1696 was detected, peak Pb concentrations (>10,000 µg g-1) and flux (39.4 g m-2 y-1) corresponded to the most intensive mining episode (1863-1871) and 20th century technological enhancements were reflected as a more muted sedimentary imprint. After careful evaluation, we used these markers to augment a Bayesian age-depth model of the independent geochronology obtained using radioisotope dating (14C, 210Pb, 137Cs and 241Am). Total inventories of Pb, Zn and Cu for the lake basin during the period of active mining were 15,415 kg, 5,897 kg and 363 kg, respectively. The post-mining trajectories for Pb and Zn project a return to pre-mining levels within 54-128 years for Pb and 75-187 years for Zn, although future remobilisation of metal-enriched catchment soils and floodplain sediments could perturb this recovery. We present a transferable paleolimnological approach that highlights flux-based assessments are vital to accurately establish the baseline, impact and trajectory of mining-derived contamination for a lake catchment

A mixed methods process evaluation of a person-centred falls prevention program

Background RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n=263) and the clinicians delivering RESPOND (n=7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n=41), and interviews were conducted with RESPOND clinicians (n=6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation – Behaviour’ (COM-B) behaviour change framework. Results RESPOND was implemented at a lower dose than the planned 10 hours over six months, with a median (IQR) of 2.9 hours (2.1, 4). The majority (76%) of participants received their first intervention session within one month of hospital discharge. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND of similar programs. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014)

Deficiency of knowledge of genetics and genetic tests among general practitioners, gynecologists, and pediatricians: A global problem

). The 5th percentile of GPs, GYNs, and PEDs was at approximately 40%, 52% and 62% correct answers, respectively. There was a specific lack of knowledge about DNA testing. In addition to specialty, important factors positively associated with the knowledge scores of nongeneticists are more recent graduation, having taken an elective course in genetics, and providing genetic counseling in their own practice. CONCLUSION:: The overall knowledge levels of genetics in many nongeneticist health care providers show clear deficiencies. This is in line with reports from other countries, showing that these deficiencies are a global proble