Leaping the Hurdles: Using an Ecological Approach to Develop Physical Education for Autistic Students: an Action Research Study

Literature demonstrates how physical activity can support the needs of autistic students. Physical activity includes all forms of physical education (PE) and school provides an important environment for physical activity in PE lessons. However, for many autistic students, these are inaccessible. This study describes how PE practice was improved collaboratively in an autism school by exploring how seven teachers, 34 teaching assistants and one senior leader engaged in action research during one academic year. Sixteen students were asked about their perspectives. Teacher and TA questionnaires revealed that PE practice pre-intervention was unfit for purpose due to insufficient subject knowledge and confidence. Thematic analysis provided direction for an intervention which included staff training, timetable changes and formation of a working party. Planning and a resource bank were created during the intervention, with working party minutes providing evidence of the process. Three semi-structured interviews with PE working party members’ post-intervention unearthed multifactorial experiences and understandings of PE for autistic students. Student preferences did not match staff perceptions which characterised a deficit model of needs. A pre- and post-intervention audit confirmed how developing a PE co-ordinator role improved practice and although staff valued PE and believed there should be a PE teacher, they maintained class-based teaching. Thus, PE lessons were outsourced post-intervention. Viewed through an ecological lens, findings indicated how teacher agency and policy discourse interacted across interconnected systems. Complex factors of environment and individual dispositions impacted staff engagement, and organisational structures of funding and staffing influenced staff enactment of the PE intervention. Further research and strategic direction are required to map PE initiatives focussing on change in a local context with wider implications of initial teacher training and models of professional learning. Recommendations for PE practice in autism schools and beyond are discussed and a pathway for pedagogical change is presented

Some East African Hawk Moths

Volume: XXI

Changes in wine consumption are influenced most by health: results from a population survey of South Australians in 2013

Aims: Individuals change their wine consumption over their life course, and mean volume typically declines with increasing age. Research on the reasons individuals change their consumption has primarily focused on youth/the young, but not on older adults. This study’s aim was to ascertain changes in wine consumption over a 12-month period in Australians at different ages and what influenced these changes. Methods: As part of the Spring 2013 South Australian Health Omnibus Survey, persons (n=2,908) aged 15 years and over who had most recently had a birthday in the selected household were interviewed in their home by trained interviewers. Of these, 48.9% were males and their mean age was 46.3 (standard deviation 18.9) years. Results: Regular, light–moderate wine consumers were generally stable in the amount of wine they drank over a 12 month period, particularly those aged 55 years and older. They generally cited health (48.0%) as a reason for decreasing their wine consumption. Those who usually consumed three to four standard drinks on days they drank wine were also more likely to give health (54.3%) as a reason for decreasing their consumption, as were heavy wine consumers (57.7%). The 25- to 34-year age-group was more likely to have decreased (36% vs 26%) their wine consumption in the last 12 months. The 15- to 24-year age-group was most likely to have increased (28% vs 10%) their wine consumption in the last 12 months. Health was most cited as the reason for decreasing this consumption, while family and friends were most cited as the reason for increasing this consumption. Conclusion: In this representative population of South Australians, the wine consumption of previously identified at-risk groups for both short- and long-term harms, ie, youth and older adults, as well as excessive and heavy drinkers, was most influenced by health, family and friends, and employment.Creina S Stockley, Anne W Taylor, Alicia Montgomerie, Eleonora Dal Grand

Walk to the Beat: A Case Report of the Use of a Novel Haptic Device to Improve Walking after Stroke

Background: Stroke affects 15 million people worldwide every year and leaves two-thirds of survivors with significant mobility deficits including reduced walking speed, increased unevenness of step length and asymmetry. Haptic cues, which utilise sensory stimulation and so are unaffected by visual or auditory interference could discreetly improve the gait of people after stroke. Therefore, the objective of this single mixed methods case study was to evaluate the use of a novel haptic device in a single participant after stroke.Context and purpose: After initial familiarisation, gait symmetry, walking speed and cadence of a 69 year old male stroke survivor were recorded using a Qualisys Motion Capture system whilst he walked on a ten metre walkway, firstly without and then with a haptic device on each leg, which provided a metronomic rhythmical vibratory cue. The participant then provided a user evaluation of the devices using a semi structured interview.Results: The haptic device was evaluated positively by the participant although he noted it needed to be refined to increase its wear-ability and acceptability for everyday use. Whilst gait speed and cadence remained unaltered, there was a 14% improvement in temporal gait symmetry when wearing the haptic device, suggesting it improved this aspect of gait.Conclusion: Whilst limited by its design, the findings of this single case study indicate that the haptic device could be a novel technology-based therapeutic adjunct to improve gait symmetry after stroke. It also provides key understanding of user needs which can be used to guide the development of a new prototype device for stroke survivors.Brief summary: Many stroke survivors have residual mobility problems. Haptic cueing may improve walking by providing a tactile cue that the participant follows to improve symmetry. This single case study suggests that gait symmetry could be improved by haptic cueing and indicates factors affecting the wear ability of such a device.</br

Genomic RNA folding mediates assembly of human parechovirus

Assembly of the major viral pathogens of the Picornaviridae family is poorly understood. Human parechovirus 1 is an example of such viruses that contains 60 short regions of ordered RNA density making identical contacts with the protein shell. We show here via a combination of RNA-based systematic evolution of ligands by exponential enrichment, bioinformatics analysis and reverse genetics that these RNA segments are bound to the coat proteins in a sequence-specific manner. Disruption of either the RNA coat protein recognition motif or its contact amino acid residues is deleterious for viral assembly. The data are consistent with RNA packaging signals playing essential roles in virion assembly. Their binding sites on the coat proteins are evolutionarily conserved across the Parechovirus genus, suggesting that they represent potential broad-spectrum anti-viral targets.Peer reviewe

Consensus recommendations for mrd testing in adult b-cell acute lymphoblastic leukemia in ontario

Measurable (minimal) residual disease (MRD) is an established, key prognostic factor in adult B-cell acute lymphoblastic leukemia (B-ALL), and testing for MRD is known to be an important tool to help guide treatment decisions. The clinical value of MRD testing depends on the accuracy and reliability of results. Currently, there are no Canadian provincial or national guidelines for MRD testing in adult B-ALL, and consistent with the absence of such guidelines, there is no uniform Ontario MRD testing consensus. Moreover, there is great variability in Ontario in MRD testing with respect to where, when, and by which technique, MRD testing is performed, as well as in how the results are interpreted. To address these deficiencies, an expert multidisciplinary working group was convened to define consensus recommendations for improving the provision of such testing. The expert panel recommends that MRD testing should be implemented in a centralized manner to ensure expertise and accuracy in testing for this low volume indication, thereby to provide accurate, reliable results to clinicians and patients. All adult patients with B-ALL should receive MRD testing after induction chemotherapy. Philadelphia chromosome (Ph)-positive patients should have ongoing monitoring of MRD during treatment and thereafter, while samples from Ph-negative B-ALL patients should be tested at least once later during treatment, ideally at 12 to 16 weeks after treatment initiation. In Ph-negative adult B-ALL patients, standardized, ideally centralized, protocols must be used for MRD testing, including both flow cytometry and immunoglobulin (Ig) heavy chain and T-cell receptor (TCR) gene rearrangement analysis. For Ph-positive B-ALL patients, MRD testing using a standardized protocol for reverse transcription real-time quantitative PCR (RT-qPCR) for the BCR-ABL1 gene fusion transcript is recommended, with Ig/TCR gene rearrangement analysis done in parallel likely providing additional clinical information

A blended user centred design study for wearable haptic gait rehabilitation following hemiparetic stroke

Restoring mobility and rehabilitation of gait are high priorities for post-stroke rehabilitation. Cueing using metronomic rhythmic sensory stimulation has been shown to improve gait, but most versions of this approach have used auditory and visual cues. In contrast, we developed a prototype wearable system for rhythmic cueing based on haptics, which was shown to be highly effective in an early pilot study. In this paper we describe a follow-up study with four stroke survivors to inform design, and to identify issues and requirements for such devices to be used in home-based or out-door settings. To this end, we present a blended user-centred design study of a wearable haptic gait rehabilitation system. This study draws on the combined views of physiotherapists, nurses, interaction designers and stroke survivors. Many of the findings were unanticipated, identifying issues outside the scope of initial designs, with important implications for future design and appropriate use

Increasing the Metabolic Stress of an Unweighted Knee Exercise via Blood-flow Restriction Training: A Potential Treatment Adjunct for Physiotherapists

Background: Blood-flow Restriction Training [BfRT] involves the temporary, artificial reduction of blood flow through a limb, often during low-intensity resistance exercise. Following lower-limb injury or surgery, evidence suggests that BfRT can be used to minimise losses in thigh muscle size and strength or accelerate their return. However, the restriction equipment used in BfRT research is often inaccessible to frontline clinicians. There is also little evidence as to the acute metabolic effect of adding blood-flow restriction to un-resisted, or ‘no load’, rehabilitation exercises. Purpose: Using an inexpensive restriction device, this study investigated whether adding lower-limb bloodflow restriction to a rehabilitation-appropriate ‘no load’ knee exercise produced a significant change in the acute metabolic stress of the exercise session. Methods: The height, weight and leg measurements of n=16 healthy participants (n=9 male) were recorded. Participants attended four exercise sessions separated by at least 48 hours. Each session consisted of three, one-minute sets of a single-leg, unweighted knee-extension exercise. Throughout all sessions a 21cm-wide thigh blood-pressure cuff was wrapped around the thigh of the exercising limb. During the first exercise session the cuff was not inflated [control]. Over the remaining three sessions, the cuff was inflated to one preselected pressure [40/60/80mmHg] in order to restrict blood flow through the exercising limb. At the start of these sessions, the percentage of popliteal arterial blood-flow volume remaining after cuff inflation [BfR] was determined using Doppler ultrasound. To indicate metabolic stress, near infra-red spectroscopy was used to record deoxygenated haemoglobin mass [HHb] of the vastus lateralis muscle before and during every exercise session. Cohort differences in BfR and HHb change for each exercise session were then compared. Results: All participants completed all exercise sessions. BfR decreased as cuff pressure was increased, with 80mmHg inducing a mean BfR of 47.6% (95% CI 42.9% - 52.3%). HHb of the vastus lateralis muscle did not increase during the control session. HHb of the vastus lateralis muscle increased significantly when cuff pressures were applied during the three remaining sessions. (Repeated Measures ANOVA, p< 0.001, partial η2 0.65). Overall, a higher Body Mass Index was associated with smaller changes in HHb of the vastus lateralis muscle during sessions in which cuff pressures were applied (Pearson R -0.794, R² 0.630, p < 0.001). Conclusions: Results indicate that adding lower-limb blood-flow restriction significantly increased the local, acute metabolic stress of a rehabilitation-appropriate knee exercise without the need to increase exercise load or repetitions. At cuff pressures up to 80mmHg, the degree of metabolic stress experienced during ‘no load’ BfRT differed between individuals and was associated with their Body Mass Index. Implications: Using an inexpensive blood-pressure cuff as the restriction device, findings support the potential use of lower-limb BfRT as a treatment adjunct following lower-limb injury. To deliver a consistent level of metabolic stress among different individuals, clinicians may need to tailor the amount of thigh cuff pressure that they apply based upon an individual’s physical size. Further research is required to determine the potential magnitude of acute metabolic stress required to attenuate the effects of muscle disuse within injured populations

Cardiovascular disease in Alpha 1 antitrypsin deficiency:an observational study assessing the role of neutrophil proteinase activity and the suitability of validated screening tools

Background: Alpha 1 Antitrypsin Deficiency (AATD) is a rare, inherited lung disease which shares features with Chronic Obstructive Pulmonary Disease (COPD) but has a greater burden of proteinase related tissue damage. These proteinases are associated with cardiovascular disease (CVD) in the general population. It is unclear whether patients with AATD have a greater risk of CVD compared to usual COPD, how best to screen for this, and whether neutrophil proteinases are implicated in AATD-associated CVD. This study had three aims. To compare CVD risk in never-augmented AATD patients to non-AATD COPD and healthy controls (HC). To assess relationships between CVD risk and lung physiology. To determine if neutrophil proteinase activity was associated with CVD risk in AATD. Cardiovascular risk was assessed by QRISK2® score and aortic stiffness measurements using carotid-femoral (aortic) pulse wave velocity (aPWV). Medical history, computed tomography scans and post-bronchodilator lung function parameters were reviewed. Systemic proteinase 3 activity was measured. Patients were followed for 4 years, to assess CVD development. Results: 228 patients with AATD, 50 with non-AATD COPD and 51 healthy controls were recruited. In all COPD and HC participants, QRISK2® and aPWV gave concordant results (with both measures either high or in the normal range). This was not the case in AATD. Once aPWV was adjusted for age and smoking history, aPWV was highest and QRISK2® lowest in AATD patients compared to the COPD or HC participants. Higher aPWV was associated with impairments in lung physiology, the presence of emphysema on CT scan and proteinase 3 activity following adjustment for age, smoking status and traditional CVD risk factors (using QRISK2® scores) in AATD. There were no such relationships with QRISK2® in AATD. AATD patients with confirmed CVD at four-year follow up had a higher aPWV but not QRISK2® at baseline assessment. Conclusion: aPWV measured CVD risk is elevated in AATD. This risk is not captured by QRISK2®. There is a relationship between aPWV, lung disease and proteinase-3 activity. Proteinase-driven breakdown of elastin fibres in large arteries and lungs is a putative mechanism and forms a potential therapeutic target for CVD in AATD

Inter-laboratory proficiency testing scheme for tumour next-generation sequencing in Ontario: A pilot study

Background A pilot inter-laboratory proficiency scheme for 5 Ontario clinical laboratories testing tumour samples for the Ontario-wide Cancer Targeted Nucleic Acid Evaluation (OCTANE) study was undertaken to assess proficiency in the identification and reporting of next-generation sequencing (NGS) test results in solid tumour testing from archival formalin-fixed, paraffin-embedded (FFPE) tissue. Methods One laboratory served as the reference centre and provided samples to 4 participating laboratories. An analyte-based approach was applied: each participating laboratory received 10 FFPE tissue specimens profiled at the reference centre, with tumour site and histology provided. Laboratories performed testing per their standard NGS tumour test protocols. Items returned for assessment included genes and variants that would be typically reported in routine clinical testing and variant call format (VCF) files to allow for assessment of NGS technical quality. Results Two main aspects were assessed: Technical quality and accuracy of identification of exonic variants Site-specific reporting practices Technical assessment included evaluation of exonic variant identification, quality assessment of the VCF files to evaluate base calling, variant allele frequency, and depth of coverage for all exonic variants. Concordance at 100% was observed from all sites in the technical identification of 98 exonic variants across the 10 cases. Variability between laboratories in the choice of variants considered clinically reportable was significant. Of the 38 variants reported as clinically relevant by at least 1 site, only 3 variants were concordantly reported by all participating centres as clinically relevant. Conclusions Although excellent technical concordance for NGS tumour profiling was observed across participating institutions, differences in the reporting of clinically relevant variants were observed, highlighting reporting as a gap where consensus on the part of Ontario laboratories is needed