Do lycra garments improve function and movement in children with cerebral palsy?

The mother of a 5-year-old boy with athetoid cerebral palsy complains of difficulties putting his Lycra suit on each day. She is keen to know if it actually helps improve his function and movement. STRUCTURED CLINICAL QUESTION In children with cerebral palsy (population), do Lycra garments (intervention) improve function and posture (outcome)? SEARCH STRATEGY The search was performed in October 2009

Bleak House and the Demise of Chancery: A Case Study in the Relationship between Fictional Literature and Legal Reform

This paper explores the relationship between fictional literature and law reform through the treatment of the Court of Chancery in Charles Dickens’s 1852-183 novel Bleak House. It offers a reading of the novel as a law reform narrative which presents a coherent picture of the state of the law as it is and an imaginative alternative for its future. The Chancery represented in the novel is mythologised and symbolic rather than strictly historically accurate, and this enables Dickens to reveal its problematic essence as a morally bankrupt and bankrupting institution. The solution the novel puts forward is two-fold: calling for its readers to participate personally in an ethic of equity and for lawmakers to reconfigure the court in a way which encourages such an ethic in its participants. Although the novel did not have a noticeable effect on the historical process of Chancery reform, it did contribute a new and counter-cultural normative vision of reform, and impacted on its readership at an individual level

A randomised controlled trial evaluating the Guide Cymru mental health literacy intervention programme in year 9 (age 13–14) school pupils in Wales

Background: Adolescent mental health has become a public health concern as 10-20% of adolescents have experiences with mental health problems. Improving mental health education is critical to reducing stigma and improving access to appropriate care when needed. Here we examine the impact of a mental health literacy programme (Guide Cymru) in young adolescents in the UK. A randomised controlled trial assessed the effectiveness of the Guide Cymru intervention. Method: A total of 1,926 pupils (860 males and 1066 females) aged 13-14 (year 9) took part in the study. The secondary schools were randomised into the active and control arms of the study. Teachers in the active arm of the study were trained on the Guide Cymru and then delivered the intervention to their pupils. Pupils in the active groups received six modules of mental health literacy (the Guide Cymru), and control schools received teaching as usual. Mental health literacy across several domains (e.g., knowledge, stigma, help-seeking intentions) were assessed both before and after the intervention. Data collection for the randomised controlled trial ran from September 2019 to March 2020. Multi-level modelling analysis was conducted to account for the clustered nature of the design. Results: All aspects of mental health literacy, including mental health knowledge (g = 0.32), good mental health behaviours (g = 0.22), mental health stigmas (g = 0.16), intentions to seek help (g = 0.15), and avoidant coping (g = 0.14) improved after completing the Guide Cymru programme (ps < .001). Discussion: The current study presents evidence for the Guide Cymru's effectiveness in improving secondary school pupils' mental health literacy. We demonstrate that providing teachers with appropriate resources and training to deliver the Guide Cymru programme within their classrooms can improve the mental health literacy of pupils. These findings have important implications for the beneficial impacts the secondary school system can have on reducing the burden of mental health problems at a critical point in a young person's life

Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities : multicentre randomised controlled trial

Objective: To evaluate the effectiveness and cost utility of a universally provided early years parenting programme. Design: Multicentre randomised controlled trial with cost-effectiveness analysis. Setting: Early years centres in four deprived areas of South Wales. Participants: Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control. Intervention: The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions. Main outcome measures: Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures. Results: There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With ‘+’ indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI −1.90 to 3.69); in supportive parenting, +0.17 (95%CI −0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485–46 578) over 5 years and £18 954 (range 11 664–25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up. Conclusions: Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains. Trial registration: The trial is registered with Current Controlled Trials ISRCTN13919732

The Use of Occupational Information to Improve Vocational Opportunities for Visually Disabled People

This research considers how occupational information can be used to improve vocational opportunities for visually disabled people. The literature shows that despite the disadvantage they experience in the labour market visually disabled people of working age. can achieve economic independence. An examination of models of support and intervention shows that the potential uses of occupational information throughout assessment and rehabilitation are not fully recognised in the UK. A study of tools used in vocational rehabilitation highlights the lack of instruments for use with visually disabled people. Literature is used to guide design of a new job analysis instrument for use with visually disabled people. The literature on organisational change provides guidance on the introduction of the new instrument. The job analysis instrument is tested and then adapted for use as a multi-purpose assessment instrument, for both job analysis and assessment of individuals, in order to facilitate job matching. To ensure that the instrument meets the needs of potential users the occupational information and vocational support needs of visually disabled people, employers and service providers are investigated. Analysis of potential user requirements highlights the limitations of job analysis as an approach to improving the vocational opportunities for visually disabled people so a vocational information system, based on the Internet, is designed. The system comprises a number of elements, namely a multi-purpose assessment instrument, occupational and vocational databases and a job matching service. One element, a vocational information database is already operational. The effects of organisational change in employer and service provider organisations are found to exert significant influence over vocational opportunities of disabled people and can present as barriers. Joint working to develop the vocational information system is recommended and this could assist with breaking down the barriers that exist between these groups

Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity : study protocol for a randomized controlled trial

Background: Effective programs to help children manage their weight are required. Families for Health focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health V1 showed sustained reductions in overweight after 2 years in a pilot evaluation, but lacks a randomized controlled trial (RCT) evidence base. Methods/design: This is a multi-center, investigator-blind RCT, with parallel economic evaluation, with a 12-month follow-up. The trial will recruit 120 families with at least one child aged 6 to 11 years who is overweight (≥91st centile BMI) or obese (≥98th centile BMI) from three localities and assigned randomly to Families for Health V2 (60 families) or the usual care control (60 families) groups. Randomization will be stratified by locality (Coventry, Warwickshire, Wolverhampton). Families for Health V2 is a family-based intervention run in a community venue. Parents/carers and children attend parallel groups for 2.5 hours weekly for 10 weeks. The usual care arm will be the usual support provided within each NHS locality. A mixed-methods evaluation will be carried out. Child and parent participants will be assessed at home visits at baseline, 3-month (post-treatment) and 12-month follow-up. The primary outcome measure is the change in the children’s BMI z-scores at 12 months from the baseline. Secondary outcome measures include changes in the children’s waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. The parents’ BMI and mental well-being, family eating/activity, parent–child relationships and parenting style will also be assessed. Economic components will encompass the measurement and valuation of service utilization, including the costs of running Families for Health and usual care, and the EuroQol EQ-5D health outcomes. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. A de novo decision-analytic model will estimate the lifetime cost-effectiveness of the Families for Health program. Process evaluation will document recruitment, attendance and drop-out rates, and the fidelity of Families for Health delivery. Interviews with up to 24 parents and children from each arm will investigate perceptions and changes made. Discussion: This paper describes our protocol to assess the effectiveness and cost-effectiveness of a parenting approach for managing childhood obesity and presents challenges to implementation. Trial registration: Current Controlled Trials ISRCTN4503220

Effects of Altering Freshwater Chemistry on Physiological Responses of Rainbow Trout to Silver Exposure

The influence of different water Cl- (50–600 μM), Ca2+ (50–1,500 μM), Na+ (50–1,500 μM), or dissolved organic carbon (DOC, 0.31–5 mg/L) levels on silver-induced physiological and biochemical perturbations of rainbow trout were investigated. Fish were acclimated to soft water (50 μM; Cl-, Ca2+, and Na+), then exposed to 3.7 μg/L Ag (as AgNO3) for 6 h, which resulted in a reduction in Na+ influx from the water, an inhibition of gill sodium- and potassium-activated adenosine triphosphatase (Na+/K+-ATPase) activity, and an accumulation of silver on the gills. Increasing the water Cl- or DOC levels ameliorated the silver toxicity. However, increasing water Ca2+ or Na+ concentration did not reduce the silver-induced physiological and biochemical perturbations. The free silver ion (Ag+) concentrations (calculated from MINEQL+, a geochemical speciation computer program) showed a negative correlation with the Na+ influx rates and gill Na+/K+-ATPase activity. However, gill silver levels did not correlate to Ag+ concentrations and no correlation was found between gill silver levels and either Na+ influx rates or gill Na+/K+-ATPase activity. These results support the notion that the [Ag+] concentration is of major importance when assessing silver toxicity in fish, and that this should be taken into account in regulatory strategies for silver in the natural environment

Remind me of the context: Memory and metacognition at restudy

Mastering study materials often requires repeated learning. However, the strategy of restudying the same materials has been criticized for not giving sufficient opportunity for retrieval in the form of self-assessments that are known to benefit not only learning but also metacognitive monitoring of the learning process. Here we focus on the contribution of retrieval processes to repeated learning that does not include explicit self-assessments. By manipulating environmental context in which restudy takes place, we demonstrate that repeated learning in the same environmental context augments both learning and metacognitive monitoring (as tapped into by immediate judgments of learning). These benefits arise because reinstated context facilitates spontaneous retrieval during learning in the form of recollection of previous study opportunities. At the same time, we demonstrate that explicit self-assessments – delayed judgments of learning – can be led astray by non-diagnostic spurious familiarity of environmental context which accompanies these assessments. The study thus reveals the positive effects of environmental context on restudy and metacognitive monitoring of restudy, while highlighting possible inaccuracies of metacognitive processes involved in explicit self-assessments of learning

The economic impact of sight loss and blindness in the UK adult population

Background: To quantify the economic impact of sight loss and blindness in the United Kingdom (UK) population, including direct and indirect costs, and its burden on health. Methods: Prevalence data on sight loss and blindness by condition, Census demographic data, data on indirect costs, and healthcare cost databases were used. Blindness was defined as best corrected visual acuity (BCVA) of < 6/60, and sight loss as BCVA < 6/12 to 6/60, in the better-seeing eye. Results: Sight loss and blindness from age-related macular degeneration (AMD), cataract, diabetic retinopathy, glaucoma and under-corrected refractive error are estimated to affect 1.93 (1.58 to 2.31) million people in the UK. Direct health care system costs were £3.0 billion, with inpatient and day care costs comprising £735 million (24.6%) and outpatient costs comprising £771 million (25.8%). Indirect costs amounted to £5.65 (5.12 to 6.22) billion. The value of the loss of healthy life associated with sight loss and blindness was estimated to be £19.5 (15.9 to 23.3) billion or £7.2 (5.9 to 8.6) billion, depending on the set of disability weights used. For comparison with other published results using 2004 disability weights and the 2008 estimates, the total economic cost of sight loss and blindness was estimated to be £28.1 (24.0 to 32.5) billion in 2013. Using 2010 disability weights, the estimated economic cost of sight loss and blindness was estimated to be £15.8 (13.5 to 18.3) billion in 2013. Conclusions: The large prevalence of sight loss and blindness in the UK population imposes significant costs on public funds, private expenditure, and health. Prevalence estimates relied on dated epidemiological studies and may not capture recent advances in treatment, highlighting the need for population-based studies that track the prevalence of sight-impairing eye conditions and treatment effects over time