Impact of simulated patients on physiotherapy students' skill performance in cardiorespiratory practice classes: a pilot study.

Purpose: To date, no evidence exists that high-fidelity simulation improves skill development among physiotherapy students in the university setting. With pressures to reduce costs and maintain or improve the quality of the learning experience, and with pressures on clinical placement, it is essential to investigate methods that might improve students’ skill performance before they undertake clinical practice. Our study set out to investigate (1) the impact of using simulated patients (SPs) in a practical class on physiotherapy students’ skill acquisition and (2) the students’ reflections on the intervention. Method: We devised a pilot study using a single-centre randomized controlled trial. A total of 28 undergraduate physiotherapy students, matched using previous practical examination grades, undertook a 2-hour practical class in which they practised their core cardiorespiratory skills. Pre-session resources were identical. The control group practised on peers; the intervention group practised on SPs. The students’ skill performance was assessed 2 weeks later using the Mini-Clinical Evaluation Exercise (MiniCEX), including gathering qualitative data from the students’ reflections. Twenty-eight students undertook the practical class and subsequent MiniCEX assessment. Results: A statistically significant difference was found for all aspects of the MiniCEX except medical interview ( p = 0.07) and physical interview (p = 0.69), and a large effect size was found for all areas except physical interview (0.154) and medical interview (0.378). The students’ reflections focused on three key themes: behaviours and attitudes, teaching the active cycle of breathing technique, and feedback. Conclusions: Our findings suggest that interacting with SPs improves student skill performance, but further research using a larger sample size and an outcome measure validated for this population is required to confirm this

Acute and chronic effects of multivitamin/mineral supplementation on objective and subjective energy measures

Background: Vitamins and minerals play an essential role within many cellular processes including energy production and metabolism. Previously, supplementation with a multivitamin/mineral (MVM) for ≥28 days resulted in improvements to cognition and subjective state. We have also demonstrated shifts in metabolism during cognitively demanding tasks following MVM in females, both acutely and following 8-week supplementation. The current study aimed to assess these effects further in males and females using metabolically challenging exercise and cognitive tasks. Methods: The current randomised, placebo-controlled, parallel groups study investigated the effects of a MVM complex in 82 healthy young (18-35y) exercisers. Subjective ratings and substrate metabolism were assessed during 30 min each of increasingly effortful incremental exercise and demanding cognitive tasks. Assessments took place on acute study days following a single dose (Day 1) of MVM, containing 3 times recommended daily allowance of water-soluble vitamins plus CoQ10, and following 4-week supplementation (Day 28). Results: Energy expenditure (EE) was increased during cognitive tasks following MVM across Day 1 and Day 28, with greater effects in males. In males, MVM also increased carbohydrate oxidation and energy expenditure during exercise across Day 1 and Day 28. In females, mental tiredness was lower during exercise; increases in physical tiredness following 30 min of exercise were attenuated; and stress ratings following cognitive tasks were reduced following MVM. In males, MVM only lowered mental tiredness following 10 min of exercise. These effects were apparent irrespective of day, but effects on mental tiredness were greater on Day 28. Ferritin levels were also higher on Day 28 in those receiving MVM. Conclusion: These findings extend on existing knowledge, demonstrating increased carbohydrate oxidation and increased energy expenditure in males following MVM supplementation for the first time. Importantly, they show modulation of energy expenditure and subjective tiredness following a single dose, providing further evidence for acute effects of MVM. Differential effects in men and women suggest that sex may play an important role in the effects of MVM on energy metabolism and should be considered in future research. Trial registration: ClinicalTrials.gov, NCT03003442. Registered 22nd November 2016 – retrospectively registere

Optimal CD4 count for initiating HIV treatment: impact of CD4 observation frequency and grace periods, and performance of dynamic marginal structural models.

BACKGROUND: In HIV infection, dynamic marginal structural models have estimated the optimal CD4 for treatment initiation to minimize AIDS/death. The impact of CD4 observation frequency and grace periods (permitted delay to initiation) on the optimal regimen has not been investigated nor has the performance of dynamic marginal structural models in moderately sized data sets-two issues that are relevant to many applications. METHODS: To determine optimal regimens, we simulated 31,000,000 HIV-infected persons randomized at CD4 500-550 cells/mm to regimens "initiate treatment within a grace period following observed CD4 first 0.5% lower AIDS-free survival compared with the true optimal regimen. CONCLUSIONS: The optimal regimen is strongly influenced by CD4 frequency and less by grace period length. Dynamic marginal structural models lack precision at moderate sample sizes

Cultural beliefs about cancer influencing help-seeking and symptom appraisal: a meta-synthesis of qualitative findings

Abstract presented at the 2014 World Cancer Congress, 3-6 December 2014, Melbourne, Australi

Post-stroke visual impairment: a systematic literature review of types and recovery of visual conditions

Aim: The aim of this literature review was to determine the reported incidence and prevalence of visual impairment due to stroke for all visual conditions including central vision loss, visual field loss, eye movement problems and visual perception problems. A further aim was to document the reported rate and extent of recovery of visual conditions post stroke. Methods: A systematic review of the literature was conducted including all languages and translations obtained. The review covered adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke. We searched scholarly online resources and hand searched journals and registers of published, unpublished and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. The quality of the evidence was assessed using key reporting guidelines, e.g. STROBE, CONSORT. Results: Sixty-one studies (n=25,672) were included in the review. Overall prevalence of visual impairment early after stroke was estimated at 65%, ranging from 19% to 92%. Visual field loss reports ranged from 5.5% to 57%, ocular motility problems from 22% to 54%, visual inattention from 14% to 82% and reduced central vision reported in up to 70%. Recovery of visual field loss varied between 0% and 72%, with ocular motility between 7% and 92% and visual inattention between 29% and 78%. Conclusion: The current literature provides a range of estimates for prevalence of visual impairment after stroke. Visual impairment post stroke is a common problem and has significant relevance to the assessment and care these patients receive. Prospective figures regarding incidence remain unknown

Assessing sampling of the fossil record in a geographically and stratigraphically constrained dataset: the Chalk Group of Hampshire, southern UK

Taphonomic, geological and sampling processes have been cited as biasing richness measurements in the fossil record, and sampling proxies have been widely used to assess this. However, the link between sampling and taxonomic richness is poorly understood, and there has been much debate on the equivalence and relevance of proxies. We approach this question by combining both historical and novel data: a historical fossil occurrence dataset with uniquely high spatial resolution from the Upper Cretaceous Chalk Group of Hampshire, UK, and a newly compiled 3D geological model that maps subsurface extent. The geological model provides rock volumes, and these are compared with exposure and outcrop area, sampling proxies that have often been conflated in previous studies. The extent to which exposure area (true rock availability) has changed over research time is also tested. We find a trend of low Cenomanian to high Turonian to Campanian raw richness, which correlates with, and is possibly driven by, the number of specimens found. After sampling standardization, an unexpected mid-Turonian peak diversity is recovered, and sampling-standardized genus richness is best predicted by rock volume, suggesting a species–area (or ‘genus–area’) effect. Additionally, total exposure area has changed over time, but relative exposure remains the same. Supplementary materials: A locality list, abundance matrix and all correlation and modelling results are available at https://doi.org/10.6084/m9.figshare.c.3592208

A rotational social work field placement model in regional health

Increases in student numbers and education providers have combined with pressures on the human services sector to create field-placement-shortage stress in many parts of Australia. In this climate some Australian social work programs have sought alternatives to the traditional, labour-intensive, one student/one field educator, single-site model of field placement. The rotation model, as an alternative, has a longer history in America, but is only recently being trialled and evaluated in Australia

Assessing sampling of the fossil record in a geographically and stratigraphically constrained dataset: the Chalk Group of Hampshire, southern UK

Taphonomic, geological and sampling processes have been cited as biasing richness measurements in the fossil record, and sampling proxies have been widely used to assess this. However, the link between sampling and taxonomic richness is poorly understood, and there has been much debate on the equivalence and relevance of proxies. We approach this question by combining both historical and novel data: a historical fossil occurrence dataset with uniquely high spatial resolution from the Upper Cretaceous Chalk Group of Hampshire, UK, and a newly compiled 3D geological model that maps subsurface extent. The geological model provides rock volumes, and these are compared with exposure and outcrop area, sampling proxies that have often been conflated in previous studies. The extent to which exposure area (true rock availability) has changed over research time is also tested. We find a trend of low Cenomanian to high Turonian to Campanian raw richness, which correlates with, and is possibly driven by, the number of specimens found. After sampling standardization, an unexpected mid-Turonian peak diversity is recovered, and sampling-standardized genus richness is best predicted by rock volume, suggesting a species–area (or ‘genus–area’) effect. Additionally, total exposure area has changed over time, but relative exposure remains the same. Supplementary materials: A locality list, abundance matrix and all correlation and modelling results are available at https://doi.org/10.6084/m9.figshare.c.3592208

Micron-sized biogenic and synthetic hollow mineral spheres occlude additives within single crystals

Incorporating additives within host single crystals is an effective strategy for producing composite materials with tunable mechanical, magnetic and optical properties. The type of guest materials that can be occluded can be limited, however, as incorporation is a complex process depending on many factors including binding of the additive to the crystal surface, the rate of crystal growth and the stability of the additives in the crystallisation solution. In particular, the size of occluded guests has been restricted to a few angstroms – as for single molecules – to a few hundred nanometers – as for polymer vesicles and particles. Here, we present a synthetic approach for occluding micrometer-scale objects, including high-complexity unicellular organisms and synthetic hollow calcite spheres within calcite single crystals. Both of these objects can transport functional additives, including organic molecules and nanoparticles that would not otherwise occlude within calcite. Therefore, this method constitutes a generic approach using calcite as a delivery system for active compounds, while providing them with effective protection against environmental factors that could cause degradation