Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic

Objective: To determine the level of agreement between a telehealth and in-person assessment of a representative sample of patients with chronic musculoskeletal conditions referred to an advanced-practice physiotherapy screening clinic. Design: Repeated-measures study design. Participants: 42 patients referred to the Neurosurgical & Orthopaedic Physiotherapy Screening Clinic (Queensland, Australia) for assessment of their chronic lumbar spine, knee or shoulder condition. Intervention: Participants underwent two consecutive assessments by different physiotherapists within a single clinic session. In-person assessments were conducted as per standard clinical practice. Telehealth assessments took place remotely via videoconferencing. Six Musculoskeletal Physiotherapists were paired together to perform both assessment types. Main outcome measures: Clinical management decisions including (i) recommended management pathways, (ii) referral to allied health professions, (iii) clinical diagnostics, and (iv) requirement for further investigations were compared using reliability and agreement statistics. Results: There was substantial agreement (83.3%; 35/42 cases) between in-person and telehealth assessments for recommended management pathways. Moderate to near perfect agreement (AC1 = 0.58–0.9) was reached for referral to individual allied health professionals. Diagnostic agreement was 83.3% between the two delivery mediums, whilst there was substantial agreement (81%; AC1 = 0.74) when requesting further investigations. Overall, participants were satisfied with the telehealth assessment. Conclusion: There is a high level of agreement between telehealth and in-person assessments with respect to clinical management decisions and diagnosis of patients with chronic musculoskeletal conditions managed in an advanced-practice physiotherapy screening clinic. Telehealth can be considered as a viable and effective medium to assess those patients who are unable to attend these services in person

Impact of August 2017 British Columbia Pyrocumulonimbus Injection Events on Lower Stratospheric Composition

On August 12-13, 2017 large wildfires in the Cariboo region of British Columbia, Canada sparked a series of pyrocumulonimbus events lifting carbonaceous aerosol and other trace gases to the tropopause region (~10-11 km). Over the subsequent days, this plume of trace gas and aerosol species was observed from numerous NASA satellite instruments to rise to over 22 km due to the strong shortwave heating of the carbonaceous aerosol. We will show observations of CO and H2O from the Microwave Limb Sounder (MLS) instrument on Aura satellite demonstrating the clear rise and spread of the plume which can be coherently tracked for at least 2 months. Enhancements in HCN, CH3CN, and methanol (CH3OH) are also evident in MLS measurements with the former two having low vertical resolution. We have also detected a significantly lower concentration of O3 and HNO3 in the plume compared to the surrounding environment, which is consistent with a dynamical perturbation from the rapid diabatic rise of the heated plume from the tropopause through the lower stratosphere. In the weeks and months that followed this plume spread over much of the Northern Hemisphere and the aerosol was observed to be slowly removed by transport back into the troposphere. We will compare and contrast the Aug. 2017 event with the other large event in the MLS record, the Feb. 2009 Australian "Black Saturday" event, and use the Goddard Earth Observing System Chemistry-Climate Model (GEOSCCM) replayed to observed meteorology to understand the effect of the British Columbia event on trace gas species. GEOSCCM helps us to separate the relative roles of dynamics and chemistry on lower stratospheric trace gas composition changes, not only in the rising plume but also the impact of its eventual spread over the Northern Hemisphere during fall and winter of 2017-2018

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is believed to affect up to 10% of women of reproductive age. It is a complex disorder that causes hyperandrogenemia and hyperinsulinemia resulting in infertility, irregular menses, acne, and hirsutism. Women with PCOS also have an increased risk for developing non-insulin dependent diabetes mellitus, dyslipidemia, ovarian cancer, and premature cardiovascular disease. The examiner should focus on the menstrual and reproductive history. The physical examination should focus on hair and acne distribution, presence of central obesity, and ovarian enlargement. The patient may or may not have polycystic ovaries as diagnosed on ultrasound. The diagnosis of PCOS is determined by a combination of ultrasonography, hirsutism, or hyperandrogenemia. The treatment of PCOS is based on symptomatic measures to treat hirsutism, obesity, irregular menses, and infertility. There is no cure for PCOS at this time

Spatial and Temporal Structure of the Tertiary Ozone Maximum in the Polar Winter Mesosphere

Observations from satellites and a ground-based station are combined to construct a global data set for investigating the tertiary ozone maximum in the winter mesosphere for the period August 2004 to June 2017. These give a comprehensive picture of this ozone maximum in latitude, pressure, and time. The location of the tertiary ozone maximum shifts in latitude and pressure with the evolving season; the ozone peak occurs at lower latitude and higher pressure around the winter solstice. Highest average nighttime ozone concentrations and greatest degree of interannual variability are seen in late winter in the Northern Hemisphere (NH). The hemispheric differences and interannual variability in nighttime ozone are related to variations of temperature, HO, and OH associated with dynamical activity. Elevated stratopause events in the NH winter are associated with transport of air that is depleted in HO and enhanced in OH; photochemistry then leads to downward displacement of the altitude of maximum ozone and enhancement in the ozone amount. Transport by planetary waves in the NH extends the region of high ozone further from the pole and leads to longitudinal variations. The analysis shows that while the tertiary ozone maximum responds to a particular radiative situation as shown in previous studies, it is also the result of very dry air found in the winter polar mesosphere. ©2018. American Geophysical Union. All Rights Reserved.The National Center for Atmospheric Research is sponsored by the National Science Foundation. A. K. S. acknowledges support from NASA award NNX16AF90G. P. J. E. was funded by the Research Council of Norway/CoE contract 223252/F50. M. L.-P was supported by the Spanish MCINN under grant ESP2014-54362-P and EC FEDER funds. The NASA satellite data used in this study are freely available: MLS: https://mls.jpl.nasa.gov/; SABER: http://saber.gats-inc.com/; and SOFIE: http://aim.hamptonu.edu/. MIPAS data used in this study are available at http://www.imkasf.kit.edu/english/308.php. The complete BAS-MRT ozone data set is available from http://doi.org/nc3

Effects of a therapeutic exercise program in children with non-cystic fibrosis bronchiectasis : A pilot randomized controlled trial

Background: In the absence of randomized controlled trials (RCTs) on the benefits of therapeutic exercise programs involving children with bronchiectasis, we undertook a pilot RCT to evaluate the effects of a play-based therapeutic exercise program on fundamental movement skill (FMS) proficiency. The effects of the program on cardiorespiratory fitness, perceived competence, and health-related quality of life (HR-QoL) were examined as secondary outcomes. Methods: Children [median (IQR) age: 6.8 (5.3–8.8) years] with bronchiectasis unrelated to cystic fibrosis were randomized to a 7-week therapeutic exercise program (n = 11) or wait-list control (n = 10). The exercise program comprised 7 × 60-min weekly sessions and was supplemented by a home-based program 2-days/week. Participants were assessed on: FMS (locomotor and object control skills) using the Test of Gross Motor Development 2nd Edition (TGMD-2); cardiovascular fitness by calculating the percent change in heart rate (%ΔHR) from rest to completion of the first stage of a submaximal treadmill test; perceived competence using Harter’s athletic competence subscale; and QoL with the PedsQL. Results: Significant group by time interactions were observed for locomotor and object control skills. Children completing the therapeutic exercise program exhibited significant improvements in both locomotor (pre 29.0 ± 2.0, post 35.2 ± 2.2, p = 0.01) and object control (pre 27.0 ± 2.0, post 35.5 ± 2.2, p = 0.01) skills, with no significant change in controls (pre 31.6 ± 2.1, post 31.8 ± 2.3 and pre 31.0 ± 2.1, post 32.3 ± 2.3, respectively). Among children completing the program, %ΔHR declined by 6% points, while %ΔHR declined only marginally among controls (0.9% points), but the group by time interaction was not statistically significant. The program had a small positive impact on competence perceptions (Cohen’s d = 0.2) and HR-QoL (Cohen’s d = 0.3). Conclusion: This pilot RCT provides preliminary evidence for the efficacy of a play-based therapeutic exercise program to improve proficiency in FMS and fitness in children with bronchiectasis. The results are sufficiently positive to warrant conducting a larger RCT testing the efficacy of the exercise program in children with bronchiectasis and/or other chronic respiratory conditions.</p

Objectively measured physical activity and sedentary behaviour in children with bronchiectasis: a cross-sectional study

BackgroundBronchiectasis is a major contributor to respiratory morbidity and health care utilization in children and youth. Current treatment guidelines for bronchiectasis recommend participation in regular physical activity (PA) to improve aerobic fitness and quality of life (QoL). However, no previous study has assessed physical activity and sedentary behavior in this patient group, and the extent to which children with bronchiectasis meet guidelines for PA is unknown. In the absence of such data, we objectively measured the PA of children with bronchiectasis and compared them to current guidelines.MethodsForty-six children with bronchiectasis between 4 to 14years (mean age 7.52.6years) were recruited from the Queensland Children's Hospital, Brisbane. Daily time in sedentary, light, and moderate-to-vigorous PA (MVPA) was measured objectively over 7days using the ActiGraph GT3X+ accelerometer and compared their values to current guidelines (minimum 60min of MVPA daily). Compliance with the daily guideline and average daily steps counts were compared to normative data from two population-based health surveys of healthy children.ResultsWe had complete measurements from 36 children. On average, they accumulated 48.6min of MVPA daily and were sedentary for similar to 7h/day. There was no statistical difference in these values between sexes or weekdays vs. weekends. Only 2 (5.6%) children met the 60-min daily MVPA recommendation compared to 42.1% of healthy children. Children with bronchiectasis accumulated 8229 steps/day (boys: 8422 +/- SD 473, girls: 8037 +/- 594), well below the recommended 12,000 steps/day. In comparison, daily step counts in healthy children ranged from 11,500-14,500 steps/day.Conclusion Children with bronchiectasis are insufficiently active for health benefit and would substantially benefit from programs to promote PA and reduce sedentary behavior

Fundamental movement skill proficiency and objectively measured physical activity in children with bronchiectasis : a cross-sectional study

Background: Bronchiectasis is a major contributor to respiratory morbidity and healthcare utilization in children. Children with bronchiectasis exhibit low levels of physical activity (PA) and poor fundamental movement skills (FMS) may be a contributing factor. However, there are no data on FMS’s in this population. The current study assessed FMS proficiency in children with bronchiectasis and examined associations with objectively measured PA. Methods: Forty-six children with bronchiectasis (mean age 7.5 ± 2.6 year, 63% Male) were recruited from the Queensland Children’s Hospital, Brisbane. PA was measured using the ActiGraph GT3X + accelerometer. Raw accelerometer data were processed into daily time spent in sedentary activities, light-intensity activities and games, walking, running, and moderate-to-vigorous activities and games using a random forest (RF) PA classification algorithm specifically developed for children. Daily MVPA was calculated by summing time spent in walking, running, and moderate-to-vigorous activities and games. FMS were assessed using the Test of Gross Motor Development 2nd Edition (TGMD-2). Results: Fewer than 5% of children demonstrated mastery in the run, gallop, hop, and leap; while fewer than 10% demonstrated mastery for the two-handed strike, overarm throw, and underarm throw. Only eight of the 46 children (17.4%) achieved their age equivalency for locomotor skills, while just four (8.7%) achieved their age equivalency for object control skills. One-way ANCOVA revealed that children achieving their age equivalency for FMS had significantly higher levels of MVPA than children not achieving their age equivalency (51.7 vs 36.7 min/day). When examined by the five activity classes predicted by the RF algorithm, children achieving their age equivalency exhibited significantly greater participation moderate-to-vigorous intensity activities and games (22.1 vs 10.7 min/day). No significant differences were observed for sedentary activities, light-intensity activities and games, walking, and running. Conclusion: Children with bronchiectasis exhibit significant delays in their FMS development. However, those who meet their age equivalency for FMS proficiency participate in significantly more daily MVPA than children who do not meet their age-equivalency. Therapeutic exercise programs designed to improve FMS proficiency are thus likely to be beneficial in this population.</p

Effects of exercise training on physical and psychosocial health in children with chronic respiratory disease: A systematic review and meta-analysis

Introduction Chronic disease in children is increasing, including the prevalence of chronic respiratory diseases such as asthma, cystic fibrosis (CF), bronchiectasis and bronchopulmonary dysplasia (BPD). The aim of this systematic review and meta-analysis was to evaluate the effects of exercise training on health outcomes in children with chronic respiratory disease. Method Five databases were searched for randomised controlled trials investigating the effects of exercise training on children with chronic respiratory disease. Following the PRISMA guidelines, eligible studies were identified and data were extracted. A meta-analysis was conducted for the outcomes cardiovascular fitness, lung function and quality of life (QoL). Results The initial search returned 3688 papers. Twenty-seven (17 in children with asthma, 10 in children with CF) were included in the systematic review and 24 of these were included in the meta-analysis. No studies were identified in children with bronchiectasis or BPD. Included papers had a total of 1009 participants aged 8-20 years. In addition to cardiovascular fitness, lung function and QoL, studies also assessed pulmonary function, respiratory muscle strength, muscular strength and inflammation. Meta-analysis showed a large significant effect size in favour of exercise for cardiovascular fitness (peak VO 2) (standard mean difference (SMD)=1.16, 95%CI 0.61 to 1.70) and QoL (SMD=1.27, 95% CI 0.72 to 1.82) as well as a small, non-significant effect size for lung function (FEV 1) (SMD=0.02, 95% CI -0.38 to 0.42). Conclusion Exercise training significantly improves cardiovascular fitness and QoL in children with asthma and CF. Further research is needed, particularly in children with bronchiectasis and BPD