Contemporary splinting practice in the UK for adults with neurological dysfunction: A cross-sectional survey

This article is made available through the Brunel Open Access Publishing Fund.Aim: To explore the contemporary splinting practice of UK occupational therapists and physiotherapists for adults with neurological dysfunction. Method: Cross-sectional online survey of members of the Association of Chartered Physiotherapists in Neurology and College of Occupational Therapists Specialist Section Neurological Practice. Results: Four hundred and twenty therapists completed the survey. Contracture management is the most common rationale for therapists splinting adults with neurological dysfunction. Other shared therapeutic goals of splinting include maintaining muscle and joint alignment, spasticity management, function, pain management and control of oedema. Considerable clinical uncertainty was uncovered in practice particularly around wearing regimens of splints. Most therapists have access to locally-derived splinting guidelines, which may contribute to this diversity of practice. Conclusions: This study provides a unique insight into aspects of contemporary splinting practice among UK therapists, who belong to a specialist neurological professional network and work in a number of different health-care settings with adults who have a neurological condition. Study findings show a wide variation in splinting practice, thereby indicating a potential need for national guidance to assist therapists in this area of clinical uncertainty. Further research is required to establish best practice parameters for splinting in neurological rehabilitation

Astrophysical Fluid Dynamics via Direct Statistical Simulation

In this paper we introduce the concept of Direct Statistical Simulation (DSS) for astrophysical flows. This technique may be appropriate for problems in astrophysical fluids where the instantaneous dynamics of the flows are of secondary importance to their statistical properties. We give examples of such problems including mixing and transport in planets, stars and disks. The method is described for a general set of evolution equations, before we consider the specific case of a spectral method optimised for problems on a spherical surface. The method is illustrated for the simplest non-trivial example of hydrodynamics and MHD on a rotating spherical surface. We then discuss possible extensions of the method both in terms of computational methods and the range of astrophysical problems that are of interest.Comment: 26 pages, 11 figures, added clarifying remarks and references, and corrected typos. This version is accepted for publication in The Astrophysical Journa

Construction Law

Since the last survey of this topic published in the fall of 2000, construction law in Virginia has continued to evolve in an array of areas involving issues such as claims on surety bonds, claims against public entities, construction-related products like Exterior Insulation Finishing Systems ( EIFS ), and mechanic\u27s liens. These changes have implicated and better defined legal principles including the no damage for delay clause on public contracts, requirements for privity in breach of warranty claims, and implied indemnification. The significant issues in construction law have arisen both in a number of significant judicial decisions, mostly from the Supreme Court of Virginia, and in amendments to statutes by the Virginia General Assembly. This article will cover most of the significant judicial decisions and statutory changes since the middle of 2000

Non-response bias in estimates of HIV prevalence due to the mobility of absentees in national population-based surveys: a study of nine national surveys

OBJECTIVES: To measure the bias in national estimates of HIV prevalence in population-based surveys caused by mobility and refusal to test. METHODS: Data from nine demographic and health surveys and AIDS indicator surveys were used. Non-responders were divided into three groups: (i) "refusals" who were interviewed but not tested; (ii) "refusals" who were present in the household but not interviewed or tested; and (iii) "absentees" who were absent from the household. Correction for HIV status was made for the non-responders using multiple imputation methods with logistic regression models based on a common set of household-level and individual-level sociodemographic and behavioural factors for those tested and stratified by mobility status. RESULTS: The non-response groups were corrected to have higher risks of HIV than those who participated in the HIV tests, although these were only detected to be statistically significant in some of the countries. In Lesotho, the corrected prevalence for the absent household members was significantly higher than for those who were present in the household. However, the adjusted prevalences differed by less than a percentage point from the prevalences observed among those who were tested, so the overall effects of non-response on national estimates of HIV prevalence are minimal. CONCLUSIONS: The results indicate that the mobility of absentees does not substantially bias estimates of HIV prevalence from population-based surveys. None the less, if levels of non-response are high or if non-responders differ greatly from those who participate in HIV testing with respect to HIV status, non-response could still bias national estimates of HIV prevalence

Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses?

PURPOSE: People with severe mental illnesses (SMI) have an increased risk of cardiovascular disease (CVD). Research in the general population suggests that social support may protect against increased CVD morbidity and mortality; however, this may not apply to those with SMI. We aimed to explore the association between perceived social support and attendance at primary care nurse CVD risk reduction clinic appointments and CVD risk-reducing behaviours in an SMI population with elevated CVD risk factors. METHODS: We used longitudinal and cross-sectional data from a randomised controlled trial on 326 adults with SMI recruited via 76 general practices in England. Multilevel regression analysis estimated the effect of perceived social support on attendance at CVD risk reduction clinic appointments over 6 months, and adherence to CVD medication, physical activity, diet, smoking and alcohol use at baseline, adjusted by age, sex, ethnicity, deprivation, psychiatric diagnosis and employment. RESULTS: Perceived social support predicted greater appointment attendance in unadjusted (IRR = 1.005; 1.000-1.010; p = 0.05) but not adjusted analysis (IRR = 1.003; 0.998-1.009; p = 0.25). Perceived social support was associated with greater adherence to medication; for each 1% increase in social support, there was a 4.2% increase in medication adherence (OR = 1.042; 1.015-1.070; p = 0.002). No association was found between greater perceived social support and greater physical activity, lower sedentary behaviour, healthier diet, lower alcohol use or being a non-smoker. CONCLUSIONS: Social support may be an important facilitator for CVD medication adherence and is potentially important for primary care appointment attendance; however, alternative strategies might be needed to help people with SMI engage in physical activity, healthier diets and to reduce their smoking and alcohol use

BCS pairing in Fermi systems with several flavors

Motivated by the prospect of Bardeen-Cooper-Schrieffer (BCS) pairing in cold fermionic gases we analyze the superfluid phase of 3 fermionic flavors in the attractive Hubbard model. We show that there are several low--lying collective pairing modes and investigate their damping due to the partially gapless nature of the single-particle spectrum. Furthermore we analyze how these modes show up in the density response of the system. Apart from the Anderson-Bogoliubov phase mode of the pairing between two flavors, the dynamical structure factor contains signatures of the gapless third flavor. This picture is found to be robust against perturbations that break the global SU(3)-symmetry of the Hamiltonian.Comment: 13 pages, 6 figure

Comparing proxy rated quality of life of people living with dementia in care homes

Background: Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. Methods: We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. Results: Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. Conclusion: Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently

Resonant Impurity States in the D-Density-Wave Phase

We study the electronic structure near impurities in the d-density-wave (DDW) state, a possible candidate phase for the pseudo-gap region of the high-temperature superconductors. We show that the local DOS near a non-magnetic impurity in the DDW state is {\it qualitatively} different from that in a superconductor with $d_{x^2-y^2}$-symmetry. Since this result is a robust feature of the DDW phase, it can help to identify the nature of the two different phases recently observed by scanning tunneling microscopy experiments in the superconducting state of underdoped Bi-2212 compounds