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

Extent of Suitable Habitats for Juvenile Striped Bass: Dynamics and Implications for Recruitment in Chesapeake Bay

The production of striped bass Morone saxatilis in Chesapeake Bay supports recreational and commercial fisheries along the Atlantic coast of the United States, but factors that contribute to high abundances of juvenile life stages are not fully understood. In this study, we characterized and quantified suitable and optimal habitat conditions in the Chesapeake Bay for two age groups of juvenile striped bass in discrete portions of the Bay: young-of-the-year (age-0) fish in shoreline and nearshore habitats, and resident sub-adults (age-1 to -4) in the mainstem and Bay-wide. We coupled information from 24 years of monthly fisheries surveys with hindcasts from a 3-D hydrodynamic model of the Bay and a numerical model of dissolved oxygen (DO) conditions. These models provided estimates of habitat conditions for 1996 to 2019 for 33 metrics of temperature, salinity, current speed, depth, DO, and physical features of habitats. Boosted regression trees were used to identify influential habitat covariates for each group, and those covariates were used to develop nonparametric habitat suitability models based on environmental conditions at the time and location of sampling. Habitat suitability indices (HSI), ranging from 0 (poor habitat) to 1 (high-quality habitat), were assigned to each grid in the 3-D model for each season in 1996 to 2019. We quantified suitable (HSI \u3e 0.5) and optimal (HSI \u3e 0.7) on a seasonal and annual basis, and across a range of environmental conditions (wet vs. dry years; warm vs. cool years). We also estimated the persistence of suitable habitats through time as the percent of years during which conditions were suitable at a given site; persistence allowed us to identify areas of the Bay and tidal tributaries that consistently supported suitable conditions for juvenile striped bass. Specific habitat conditions that defined suitable and optimal habitats for age-0 and age 1-4 striped bass varied across seasons and among years, reflecting changes in water quality conditions in Chesapeake Bay and changes in habitat use by striped bass during their first few years of life. Metrics of water quality, especially dissolved oxygen, were consistently identified as important covariates for juvenile striped bass; these conditions are of greater importance in determining habitat suitability than specific physical features especially for a highly mobile species and may be used to inform existing decision-support tools. In our study, we found no evidence that habitat use by striped bass in Chesapeake Bay was moderated by a strict threshold for any given covariate, and average to above-average abundances of striped bass were encountered in sub-suitable conditions; thus, habitat use resulted from a combination of abiotic, and likely biotic, conditions. Neither age group exhibited a statistically significant relationship between relative abundance and the extent of suitable habitats, however, for nearly all ages and seasons, relative abundance increased with greater extent of suitable habitats suggesting that detection of this relationship requires additional annual observations. A significant decrease in the extent of suitable habitat through time (1996 to present) was observed in spring and early summer, reflecting a change in suitable environmental conditions; with additional study years, declines in the relative abundance of age-0 and age 1-4 fish may be observed as suitability of habitats continues to decline. Given the high degree of interannual variability in abundance that is characteristic of estuarine-dependent species like striped bass, the availability and quantity of suitable and high-quality habitats at the scale of individual tributaries and Bay-wide may play an important role in production of this species

Seasonal and Annual Variation in the Extent of Suitable Habitats for Forage Fishes in Chesapeake Bay, 2000-2016

The sustained production of sufficient forage is critical to advancing ecosystem-based management in Chesapeake Bay. Yet factors that affect local abundances and habitat conditions necessary to support forage production remain largely unexplored. Here, we quantified suitable habitat in the Chesapeake Bay region for four key forage fishes: bay anchovy Anchoa mitchilli, juvenile spot Leiostomus xanthurus, juvenile weakfish Cynoscion regalis, and juvenile spotted hake Urophycis regia. We coupled information from 17 years of monthly fisheries surveys with hindcasts from a numerical model of dissolved oxygen (DO) conditions and a 3-D hydrodynamic model of the Bay that provided estimates of habitat conditions across 18 covariates of salinity, temperature, DO, depth, and current speed for the period 2000 to 2016. Sediment composition and distance to shore metrics were also considered. The hindcast covariates were subsampled at the times and locations of the fisheries surveys to provide dynamic habitat metrics that are not generally observed at the time of fish sampling (e.g., current velocity, salinity stratification). Hindcast covariates were also used to describe habitat conditions in areas of Chesapeake Bay that are not sampled routinely by fisheries-independent surveys such as the Potomac River and Mobjack Bay. Boosted regression trees were used to identify influential habitat covariates for each species, and these influential covariates were then used to construct habitat suitability models. Habitat suitability indices, which ranged between 0 (poor habitat) and 1 (superior habitat), were assigned to each location in the 3-D model grid for each season in 2000-2016. Based on the estimated habitat suitability index and using a GIS approach, we quantified suitable habitat (defined as habitats with a habitat suitability index \u3e 0.5) throughout the Chesapeake Bay and its tidal tributaries. Furthermore, we validated the modeling approach using out-of-sample observations from Mobjack Bay in 2010-2012. Suitable seasonal habitat extents for forage species exhibited strong seasonal and annual signals reflecting temporal heterogeneity in habitat conditions in Chesapeake Bay. Current speed, water depth, and either temperature or dissolved oxygen were identified as important covariates for the four forage species we examined, and distance to shore was important for three of the four species; thus, suitable habitat conditions resulted from a complex interplay between water quality and the physical properties of the habitat. In our study, two species exhibited a relationship between relative abundance and extent of suitable habitats – juvenile spot in summer and bay anchovy in winter; as such, estimates of the minimum habitat area required to produce a desired abundance (or biomass) of forage fish can be used to establish quantitative habitat targets or spatial thresholds that may serve as spatial reference points for management. In an ecosystem-based approach, important habitats may be targeted for protection (e.g., by limiting fishing activities that may incidentally capture or injure forage fishes) or restoration (e.g., by improving water quality conditions), thereby ensuring production of sufficient forage for predators. In addition, the consequences of aquatic habitat alterations, whether due to climate change or physical disturbances can be investigated using projections of environmental conditions and habitat suitability in the region, though these projections will introduce additional uncertainty

Radiotherapy students' perceptions of support provided by clinical supervisors

Aim: The aim of this study was to explore the experiences of radiotherapy students on clinical placement, specifically focussing on the provision of well-being support from clinical supervisors. Materials and methods: Twenty-five students from the University of the West of England and City University of London completed an online evaluation survey relating to their experiences of placement, involving Likert scales and open-ended questions. Results: The quantitative results were generally positive; however, the qualitative findings were mixed. Three themes emerged: (1) provision of information and advice; (2) an open, inclusive and supportive working environment; and (3) a lack of communication, understanding, and consistency. Findings: Students' experiences on placement differed greatly and appeared to relate to their specific interactions with different members of staff. It is suggested that additional training around providing well-being support to students may be of benefit to clinical supervisors

The Extent of Seasonally Suitable Habitats May Limit Forage Fish Production in a Temperate Estuary

The sustained production of sufficient forage is critical to advancing ecosystem-based management, yet factors that affect local abundances and habitat conditions necessary to support aggregate forage production remain largely unexplored. We quantified suitable habitat in the Chesapeake Bay and its tidal tributaries for four key forage fishes: juvenile spotted hake Urophycis regia, juvenile spot Leiostomus xanthurus, juvenile weakfish Cynoscion regalis, and bay anchovy Anchoa mitchilli. We used information from monthly fisheries surveys from 2000 to 2016 coupled with hindcasts from a spatially interpolated model of dissolved oxygen and a 3-D hydrodynamic model of the Chesapeake Bay to identify influential covariates and construct habitat suitability models for each species. Suitable habitat conditions resulted from a complex interplay between water quality and geophysical properties of the environment and varied among species. Habitat suitability indices ranging between 0 (poor) and 1 (superior) were used to estimate seasonal and annual extents of suitable habitats. Seasonal variations in suitable habitat extents in Chesapeake Bay, which were more pronounced than annual variations during 2000–2016, reflected the phenology of estuarine use by these species. Areas near shorelines served as suitable habitats in spring for juvenile spot and in summer for juvenile weakfish, indicating the importance of these shallow areas for production. Tributaries were more suitable for bay anchovy in spring than during other seasons. The relative baywide abundances of juvenile spot and bay anchovy were significantly related to the extent of suitable habitats in summer and winter, respectively, indicating that Chesapeake Bay habitats may be limiting for these species. In contrast, the relative baywide abundances of juvenile weakfish and juvenile spotted hake varied independently of the spatial extent of suitable habitats. In an ecosystem-based approach, areas that persistently provide suitable conditions for forage species such as shoreline and tributary habitats may be targeted for protection or restoration, thereby promoting sufficient production of forage for predators. Further, quantitative habitat targets or spatial thresholds may be developed for habitat-limited species using estimates of the minimum habitat area required to produce a desired abundance or biomass; such targets or thresholds may serve as spatial reference points for management

Penaeid Shrimp in Chesapeake Bay: Population Growth and Black Gill Disease Syndrome

Since 1991, the number of penaeid shrimp occurring in Virginia waters of Chesapeake Bay has steadily increased, prompting an interest in developing a fishery. Although development of a shrimp fishery in the Chesapeake Bay region could bring economic benefits, the fishery may be hampered by the presence of a disease syndrome known as shrimp black gill (sBG). The objectives of our study were to (1) describe the spatial distribution and abundance patterns of shrimp in Chesapeake Bay, (2) relate relative abundance of shrimp to habitat characteristics, and (3) determine the presence and seasonality of sBG to better understand disease dynamics in the region. Subadult penaeid shrimp were collected monthly from Virginia waters by trawl from 1991 to 2017, and individuals were identified to species and counted. White shrimp Litopenaeus setiferus were the most numerous species captured, followed by brown shrimp Farfantepenaeus aztecus and pink shrimp F. duorarum. Shrimp were captured primarily from July to December. White shrimp were the only species that exhibited visible signs of sBG, which was first observed in October 2016 (13.4% prevalence); the condition continued into November and recurred the following year. Shrimp with visible signs of gill disease were examined by microscopy, histology, and PCR assay and were diagnosed with infections of a histophagous apostome ciliate, presumably Hyalophysa lynni. Any impacts of sBG on shrimp survival or marketability should be considered in fishery management plans to ensure sustainability of the resource

Discrete quantum gravity in the framework of Regge calculus formalism

An approach to the discrete quantum gravity based on the Regge calculus is discussed which was developed in a number of our papers. Regge calculus is general relativity for the subclass of general Riemannian manifolds called piecewise flat ones. Regge calculus deals with the discrete set of variables, triangulation lengths, and contains continuous general relativity as a particular limiting case when the lengths tend to zero. In our approach the quantum length expectations are nonzero and of the order of Plank scale $10^{-33}cm$. This means the discrete spacetime structure on these scales.Comment: LaTeX, 16 pages, to appear in JET

Regge Calculus as a Fourth Order Method in Numerical Relativity

The convergence properties of numerical Regge calculus as an approximation to continuum vacuum General Relativity is studied, both analytically and numerically. The Regge equations are evaluated on continuum spacetimes by assigning squared geodesic distances in the continuum manifold to the squared edge lengths in the simplicial manifold. It is found analytically that, individually, the Regge equations converge to zero as the second power of the lattice spacing, but that an average over local Regge equations converges to zero as (at the very least) the third power of the lattice spacing. Numerical studies using analytic solutions to the Einstein equations show that these averages actually converge to zero as the fourth power of the lattice spacing.Comment: 14 pages, LaTeX, 8 figures mailed in separate file or email author directl

A fully (3+1)-D Regge calculus model of the Kasner cosmology

We describe the first discrete-time 4-dimensional numerical application of Regge calculus. The spacetime is represented as a complex of 4-dimensional simplices, and the geometry interior to each 4-simplex is flat Minkowski spacetime. This simplicial spacetime is constructed so as to be foliated with a one parameter family of spacelike hypersurfaces built of tetrahedra. We implement a novel two-surface initial-data prescription for Regge calculus, and provide the first fully 4-dimensional application of an implicit decoupled evolution scheme (the ``Sorkin evolution scheme''). We benchmark this code on the Kasner cosmology --- a cosmology which embodies generic features of the collapse of many cosmological models. We (1) reproduce the continuum solution with a fractional error in the 3-volume of 10^{-5} after 10000 evolution steps, (2) demonstrate stable evolution, (3) preserve the standard deviation of spatial homogeneity to less than 10^{-10} and (4) explicitly display the existence of diffeomorphism freedom in Regge calculus. We also present the second-order convergence properties of the solution to the continuum.Comment: 22 pages, 5 eps figures, LaTeX. Updated and expanded versio

Sequential Metabolism of 7-Dehydrocholesterol to Steroidal 5,7-Dienes in Adrenal Glands and Its Biological Implication in the Skin

Since P450scc transforms 7-dehydrocholesterol (7DHC) to 7-dehydropregnenolone (7DHP) in vitro, we investigated sequential 7DHC metabolism by adrenal glands ex vivo. There was a rapid, time- and dose-dependent metabolism of 7DHC by adrenals from rats, pigs, rabbits and dogs with production of more polar 5,7-dienes as detected by RP-HPLC. Based on retention time (RT), UV spectra and mass spectrometry, we identified the major products common to all tested species as 7DHP, 22-hydroxy-7DHC and 20,22-dihydroxy-7DHC. The involvement of P450scc in adrenal metabolic transformation was confirmed by the inhibition of this process by DL-aminoglutethimide. The metabolism of 7DHC with subsequent production of 7DHP was stimulated by forscolin indicating involvement of cAMP dependent pathways. Additional minor products of 7DHC metabolism that were more polar than 7DHP were identified as 17-hydroxy-7DHP (in pig adrenals but not those of rats) and as pregna-4,7-diene-3,20-dione (7-dehydroprogesterone). Both products represented the major identifiable products of 7DHP metabolism in adrenal glands. Studies with purified enzymes show that StAR protein likely transports 7DHC to the inner mitochondrial membrane, that 7DHC can compete effectively with cholesterol for the substrate binding site on P450scc and that the catalytic efficiency of 3βHSD for 7DHP (Vm/Km) is 40% of that for pregnenolone. Skin mitochondria are capable of transforming 7DHC to 7DHP and the 7DHP is metabolized further by skin extracts. Finally, 7DHP, its photoderivative 20-oxopregnacalciferol, and pregnenolone exhibited biological activity in skin cells including inhibition of proliferation of epidermal keratinocytes and melanocytes, and melanoma cells. These findings define a novel steroidogenic pathway: 7DHC→22(OH)7DHC→20,22(OH)27DHC→7DHP, with potential further metabolism of 7DHP mediated by 3βHSD or CYP17, depending on mammalian species. The 5–7 dienal intermediates of the pathway can be a source of biologically active vitamin D3 derivatives after delivery to or production in the skin, an organ intermittently exposed to solar radiation