Physiotherapy rehabilitation for osteoporotic vertebral fracture (PROVE) : study protocol for a randomised controlled trial

Background: Osteoporosis and vertebral fracture can have a considerable impact on an individual’s quality of life. There is increasing evidence that physiotherapy including manual techniques and exercise interventions may have an important treatment role. This pragmatic randomised controlled trial will investigate the clinical and cost-effectiveness of two different physiotherapy approaches for people with osteoporosis and vertebral fracture, in comparison to usual care. Methods/Design: Six hundred people with osteoporosis and a clinically diagnosed vertebral fracture will be recruited and randomly allocated to one of three management strategies, usual care (control - A), an exercise-based physiotherapy intervention (B) or a manual therapy-based physiotherapy intervention (C). Those in the usual care arm will receive a single session of education and advice, those in the active treatment arms (B + C) will be offered seven individual physiotherapy sessions over 12 weeks. The trial is designed as a prospective, adaptive single-blinded randomised controlled trial. An interim analysis will be completed and if one intervention is clearly superior the trial will be adapted at this point to continue with just one intervention and the control. The primary outcomes are quality of life measured by the disease specific QUALLEFO 41 and the Timed Loaded Standing test measured at 1 year. Discussion: There are a variety of different physiotherapy packages used to treat patients with osteoporotic vertebral fracture. At present, the indication for each different therapy is not well defined, and the effectiveness of different modalities is unknown

Biowaste to biochar: hydrothermal carbonisation & high temperature torrefaction of food waste anaerobic digestate

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Factors that promote a positive childbearing experience : a qualitative study

Introduction: Experiences of pregnancy and birth are important and have long-term impacts on the well-being of women and their families. Perinatal services should aim for care that promotes a positive childbearing experience, as well as optimizing health outcomes for the woman and newborn. This study aimed to understand the health system factors that promote a positive childbearing experience. Methods: Women who had a positive experience and had given birth in Australia in the previous 12 months were recruited for individual semistructured interviews. The interview guide focused on health system factors that participants credited with contributing to their positive experience of perinatal care. Interviews were conducted until data saturation was reached. Qualitative data were transcribed verbatim and analyzed using inductive thematic analysis. Results: Data from 36 interviews were thematically analyzed, and 4 major themes were generated: health care provider attributes, health system attributes, communication and decision-making, and experience of care. The salient factors that promoted positive experiences included care that was respectful and individualized with effective communication, access to midwifery continuity of care models, and good integration between services. Competent and professional health care providers who facilitated shared decision-making were also essential. Discussion: Although women often sought out care that promoted physiologic birth, they emphasized that the way they were cared for was more important than fulfilling specific birth aspirations. Quality maternity care has the capacity to support a woman's confidence in her own abilities and promote a positive, and sometimes transformative, childbearing experience. © 2022 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM)

Improving the impact of amphibian conservation

Enhancing efforts to conserve amphibians will help ameliorate a sixth mass extinction event. In this thesis, I analyse current perceptions of success in amphibian conservation, and review the quantity and content of conservation-related scientific studies with a view to improving conservation impact. Achieving and measuring success is dependent on the way success is defined. Perceptions of success among practitioners and scientists were predominantly associated with improving the status of target species and habitats; specifically stabilising or increasing population trajectories. However, respondents with fewer years of experience view the human dimensions of conservation – such as public education, engagement, and capacity building – to be increasingly more important in defining success. This may have repercussions for interdisciplinary conservation action in the future. Secondly, the availability of relevant literature is crucial for science-based and accountable decision-making. Amphibian research is not meeting conservation needs, particularly in terms of threatened species, prevalent threats such as habitat loss and fragmentation, and studies relevant to conservation management. Improving the impact of conservation action requires the effectiveness of interventions to be tested in diverse contexts. Evidence is unrepresentative geographically, with just 10% of all studies conducted in the tropics, and there is also a deficiency for threatened species. Available evidence is unrelated to the number of amphibian conservation scientists per country. Threat mitigation studies for certain stressors (pollution, exploitation, climate change) is very limited or non-existent, and education and engagement initiatives are poorly represented, restricting understanding of the social dynamics of amphibian conservation. This limits what can currently be deduced about effective conservation practice. An expert assessment of global evidence found that over half of conservation interventions are ineffective and/or harmful, or effectiveness is unknown due to limited evidence. My findings indicate clear directions for future conservation-related research: social aspects of amphibian conservation require greater attention; research should be made more relevant to conservation objectives, focusing on neglected species, threats and approaches to conservation practice; developing increased global collaboration and capacity building is crucial to addressing knowledge gaps, as is generating the necessary funding opportunities; and a culture of evidence-based conservation should be promoted. Improving amphibian conservation impact will require a paradigm shift to enhance interdisciplinary action, increase innovation, and enable this cause to be understood and supported globally by conservation agencies, policy-makers, and funding bodies. This can be achieved through targeted and coordinated action from existing global networks in amphibian conservation science and practice

1. Amphibian Conservation

Expert assessors Ariadne Angulo, Co-Chair of the Amphibian Specialist Group, Peru Robert Brodman, Saint Joseph’s College, Indiana, USA Andrew Cunningham, Institute of Zoology, Zoological Society of London, UK Jeff Dawson, Durrell Wildlife Conservation Trust, UK Rob Gandola, University of Southampton, UK Jaime García Moreno, International Union for Conservation of Nature, The Netherlands Trent Garner, Institute of Zoology, Zoological Society of London, UK Richard Griffiths, Durrell Institute o..

Assessing the Relationship of Patient Reported Outcome Measures With Functional Status in Dysferlinopathy: A Rasch Analysis Approach

Dysferlinopathy is a muscular dystrophy with a highly variable functional disease progression in which the relationship of function to some patient reported outcome measures (PROMs) has not been previously reported. This analysis aims to identify the suitability of PROMs and their association with motor performance.Two-hundred and four patients with dysferlinopathy were identified in the Jain Foundation's Clinical Outcome Study in Dysferlinopathy from 14 sites in 8 countries. All patients completed the following PROMs: Individualized Neuromuscular Quality of Life Questionnaire (INQoL), International Physical Activity Questionnaire (IPAQ), and activity limitations for patients with upper and/or lower limb impairments (ACTIVLIMs). In addition, nonambulant patients completed the Egen Klassifikation Scale (EK). Assessments were conducted annually at baseline, years 1, 2, 3, and 4. Data were also collected on the North Star Assessment for Limb Girdle Type Muscular Dystrophies (NSAD) and Performance of Upper Limb (PUL) at these time points from year 2. Data were analyzed using descriptive statistics and Rasch analysis was conducted on ACTIVLIM, EK, INQoL. For associations, graphs (NSAD with ACTIVLIM, IPAQ and INQoL and EK with PUL) were generated from generalized estimating equations (GEE). The ACTIVLIM appeared robust psychometrically and was strongly associated with the NSAD total score (Pseudo R2 0.68). The INQoL performed less well and was poorly associated with the NSAD total score (Pseudo R2 0.18). EK scores were strongly associated with PUL (Pseudo R2 0.69). IPAQ was poorly associated with NSAD scores (Pseudo R2 0.09). This study showed that several of the chosen PROMs demonstrated change over time and a good association with functional outcomes. An alternative quality of life measure and method of collecting data on physical activity may need to be selected for assessing dysferlinopathy

Geochemical ice-core constraints on the timing and climatic impact of Aniakchak II (1628 BCE) and Thera (Minoan) volcanic eruptions

This work was supported by funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement 820047 to M.Si.), the Malcolm H. Wiener Foundation (Interdisciplinary Chronology of Civilizations Project to C.P.) and a UKRI Future Leader Fellowship (MR/S035478/1 to P.A).Decades of research have focused on establishing the exact year and climatic impact of the Minoan eruption of Thera, Greece (c.1680–1500 BCE). Ice cores offer key evidence to resolve this controversy, but attempts have been hampered by a lack of multi-volcanic event synchronization between records. In this study, Antarctic and Greenland ice-core records are synchronized using a double bipolar sulfate marker and calendar dates are assigned to each eruption revealed within the ‘Thera period’. From this global scale sequence of volcanic sulfate loading, we derive indications towards each eruption’s latitude and potential to disrupt the climate system. Ultra-fine sampling for sulfur isotopes and tephra conclusively demonstrate a colossal eruption of Alaska’s Aniakchak II as the source of stratospheric sulfate in the now precisely dated 1628 BCE ice layer. These findings end decades of speculation that Thera was responsible for the 1628 BCE event, and place Aniakchak II (52 ± 17 Tg S) and an unknown volcano at 1654 BCE (50 ± 13 Tg S) as two of the largest Northern Hemisphere sulfur injections in the last 4000 years. This opens possibilities to explore widespread climatic impacts for contemporary societies and, in pinpointing Aniakchak II, confirms that stratospheric sulfate can be globally distributed from eruptions outside the tropics. Dating options for Thera are reduced to a series of precisely dated, constrained stratospheric sulfur injection events at 1611 BCE, 1562-1555 BCE and c.1538 BCE which are all below 14 ± 5 Tg S, indicating a climatic forcing potential for Thera well below that of Tambora (1815 CE).Publisher PDFPeer reviewe

Fatal Exudative Dermatitis (FED) in Island Populations of Red Squirrels (Sciurus vulgaris): Spillover of a Virulent Staphylococcus aureus Clone (ST49) From Reservoir Hosts.

Fatal exudative dermatitis (FED) is a significant cause of death of red squirrels (Sciurus vulgaris) on the island of Jersey in the Channel Islands where it is associated with a virulent clone of Staphylococcus aureus, ST49. S. aureus ST49 has been found in other hosts such as small mammals, pigs and humans, but the dynamics of carriage and disease of this clone, or any other lineage in red squirrels, is currently unknown. We used whole-genome sequencing to characterize 228 isolates from healthy red squirrels on Jersey, the Isle of Arran (Scotland) and Brownsea Island (England), from red squirrels showing signs of FED on Jersey and the Isle of Wight (England) and a small number of isolates from other hosts. S. aureus was frequently carried by red squirrels on the Isle of Arran with strains typically associated with small ruminants predominating. For the Brownsea carriage, S. aureus was less frequent and involved strains associated with birds, small ruminants and humans, while for the Jersey carriage S. aureus was rare but ST49 predominated in diseased squirrels. By combining our data with publicly available sequences, we show that the S. aureus carriage in red squirrels largely reflects frequent but facile acquisitions of strains carried by other hosts sharing their habitat ('spillover'), possibly including, in the case of ST188, humans. Genome-wide association analysis of the ruminant lineage ST133 revealed variants in a small number of mostly bacterial-cell-membrane-associated genes that were statistically associated with squirrel isolates from the Isle of Arran, raising the possibility of specific adaptation to red squirrels in this lineage. In contrast there is little evidence that ST49 is a common carriage isolate of red squirrels and infection from reservoir hosts such as bank voles or rats, is likely to be driving the emergence of FED in red squirrels

Quantifying spatial variability in shell midden formation in the Farasan Islands, Saudi Arabia

During the past decade, over 3000 shell middens or shell matrix deposits have been discovered on the Farasan Islands in the southern Red Sea, dating to the period c. 7,360 to 4,700 years ago. Many of the sites are distributed along a palaeoshoreline which is now 2–3 m above present sea level. Others form clusters with some sites on the shoreline and others located inland over distances of c. 30 m to 1 km. We refer to these inland sites as ‘post-shore’ sites. Following Meehan, who observed a similar spatial separation in shell deposition in her ethnographic study of Anbarra shellgathering in the Northern Territory of Australia, we hypothesise that the shoreline sites are specialised sites for the processing or immediate consumption of shell food, and the post-shore sites are habitation sites used for a variety of activities. We test this proposition through a systematic analysis of 55 radiocarbon dates and measurement of shell quantities from the excavation of 15 shell matrix sites in a variety of locations including shoreline and post-shore sites. Our results demonstrate large differences in rates of shell accumulation between these two types of sites and selective removal of shoreline sites by changes in sea level. We also discuss the wider implications for understanding the differential preservation and visibility of shell-matrix deposits in coastal settings in other parts of the world extending back into the later Pleistocene in association with periods of lower sea level. Our results highlight the importance of taphonomic factors of post-depositional degradation and destruction, rates of shell accumulation, the influence on site location of factors other than shell food supply, and the relative distance of deposits from their nearest palaeoshorelines as key variables in the interpretation of shell quantities. Failure to take these variables into account when investigating shells and shell-matrix deposits in late Pleistocene and early Holocene contexts is likely to compromise interpretations of the role and significance of shell food in human evolutionary and socio-cultural development

Emerging biological archives can reveal ecological and climatic change in Antarctica

Anthropogenic climate change is causing observable changes in Antarctica and the Southern Ocean including increased air and ocean temperatures, glacial melt leading to sea-level rise and a reduction in salinity, and changes to freshwater water availability on land. These changes impact local Antarctic ecosystems and the Earth's climate system. The Antarctic has experienced significant past environmental change, including cycles of glaciation over the Quaternary Period (the past similar to 2.6 million years), Understanding Antarctica's paleoecosystems, and the corresponding paleoenvironments and climates that have shaped them, provides insight into present day ecosystem change, and importantly, helps constrain model projections of future change. Biological archives such as extant moss beds and peat profiles, biological proxies in lake and marine sediments, vertebrate animal colonies, and extant terrestrial and benthic marine invertebrates, complement other Antarctic paleoclimate archives by recording the nature and rate of past ecological change, the paleoenvironmental drivers of that change, and constrain current ecosystem and climate models. These archives provide invaluable information about terrestrial ice-free areas, a key location for Antarctic biodiversity, and the continental margin which is important for understanding ice sheet dynamics. Recent significant advances in analytical techniques (e.g., genomics, biogeochemical analyses) have led to new applications and greater power in elucidating the environmental records contained within biological archives. Paleoecological and paleoclimate discoveries derived from biological archives, and integration with existing data from other paleoclimate data sources, will significantly expand our understanding of past, present, and future ecological change, alongside climate change, in a unique, globally significant region