Which test is best? Strength testing neurological rehabilitation

Muscle weakness is the primary impairment affecting people with neurological conditions. Despite its significance to both clinicians and patients, the gold standard measure is largely restricted to laboratory settings for research purposes. Therefore, measuring muscle strength in a clinical setting is a common challenge. Our current tests often lack specificity, they are not clinically feasible nor responsive to important changes in function. While our findings show the LC leg press test to be the most appropriate test for this cohort, it is clear that a perfect clinical measure of lower limb muscle strength does not exist. Clinicians must balance the clinical utility of MMT and field testing (STS), alongside the more psychometrically sound LC test and HHD and continue to bridge the gap between current gold-standard measurements and practical clinical options.måsjekke

Case report: Dravet syndrome, feeding difficulties and gastrostomy

Dravet syndrome (DS) is a developmental and epileptic encephalopathy associated with variants in the voltage-gated sodium channel alpha 1 subunit (SCN1A) gene in around 90% of individuals. The core phenotype is well-recognized, and is characterized by seizure onset in infancy, typically with prolonged febrile seizures, followed by the emergence of multiple seizure types that are frequently drug-resistant, developmental delay, and intellectual disability. Comorbidities are common and include autism spectrum disorder, gait impairment, scoliosis, and sleep disorder. Feeding difficulties and weight loss are frequently reported by DS caregivers, and negatively impact quality of life, yet have received little attention. Here we report an adult with DS who developed reduced food and fluid intake in adolescence, resulting in weight loss and malnutrition. No underlying cause for her feeding difficulties was identified, and she subsequently required insertion of a percutaneous endoscopic gastrostomy. We review the occurrence of feeding difficulties in people with DS and discuss potential mechanisms

Hidden Voices: A Qualitative Study of Cervical and Breast Screening Experiences for Women with Mild Intellectual Disability Living in the Community

This paper reports on the issue of gynaecological screening for women with intellectual disability living in the Australian community. A qualitative study using grounded theory was conducted with data collected through semi-structured interviews and focus groups. The participants were 31 women with mild intellectual disability and four of their carers, with some additional information contributed by health professionals. Themes emerging from the data identified barriers to cervical and breast screening services, as well as factors that appeared to facilitate the participants' access to screening. The study found three sets of linked factors influencing screening impetus. These were participant attributes such as knowledge level and ability to assess own risk, the relationships of the clients with significant others such as paid and unpaid carers, and health service provider behaviours that promoted respectful individualised consultations with adequate time for communication, explanation and education. Conclusions from this study were that gynaecological screening of disadvantaged groups is likely to be increased by health education programs for consumers, as well as their carers and health service providers which focus on the specific issues for this group. The study also confirms what is already known from disease prevention campaigns aiming to improve screening and immunization rates: That proactive strategies such as health professionals offering gynaecological procedures in a sensitive manner to clients and registers that send out consumer reminder letters can substantially improve screening rates and support this consumer group's right to quality of life

A Prospective Study of Prepregnancy Dietary Iron Intake and Risk for Gestational Diabetes Mellitus

OBJECTIVE It is important to identify modifiable factors that may lower gestational diabetes mellitus (GDM) risk. Dietary iron is of particular interest given that iron is a strong prooxidant, and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism. The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM. RESEARCH DESIGN AND METHODS A prospective study was conducted among 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses’ Health Study II. A total of 867 incident GDM cases were reported. Pooled logistic regression was used to estimate the relative risk (RR) of GDM by quintiles of iron intake controlling for dietary and nondietary risk factors. RESULTS Dietary heme iron intake was positively and significantly associated with GDM risk. After adjusting for age, BMI, and other risk factors, RRs (95% CIs) across increasing quintiles of heme iron were 1.0 (reference), 1.11 (0.87–1.43), 1.31 (1.03–1.68), 1.51 (1.17–1.93), and 1.58 (1.21–2.08), respectively (P for linear trend 0.0001). The multivariate adjusted RR for GDM associated with every 0.5-mg per day of increase in intake was 1.22 (1.10–1.36). No significant associations were observed between total dietary, nonheme, or supplemental iron intake and GDM risk. CONCLUSIONS These findings suggest that higher prepregnancy intake of dietary heme iron is associated with an increased GDM risk

Selection of screw characteristics and operational boundary conditions to facilitate post-flush urine and faeces separation within single household sanitation systems

To ensure adequate access to sanitation in developing economies, off-grid single household sanitation has been proposed which obviates the need for significant infrastructure capital investment. Whilst treatment at this scale is most efficient when coupled to source separation (i.e. urine from faeces), existing source separation solutions have proved difficult to implement in this context. In this study, screw extrusion is therefore investigated to provide ‘post-flush’ source separation. Both screw characteristics and operational boundary conditions were evaluated. Preferential screw characteristics included tapering of the shaft and progressive pitch reduction, linked to a small extrusion aperture, the combination of which enhanced solids extrusion efficiency and promoted higher solids concentration in the extruded fraction. Whilst maximum extrusion efficiency was observed at high rotational speeds (over 400 rpm), this also promoted free water transport. Operating below 300 rpm instead introduced selectivity for transport of faecal sludge over urine, enabling phase separation. Constraining the volumetric ratio of urine to faeces also enhanced the extrusion rate of faecal sludge by increasing feed viscosity sufficient to overcome backpressure imposed by unmasticated food particles that would otherwise restrict separation. Importantly, this study demonstrates the feasibility of screw extrusion for ‘post flush’ separation of urine and faeces which constitutes a significant advancement towards realising sanitation at a single household scale

Quantification of liquid phase faecal odourants to evaluate membrane technology for wastewater reuse from decentralised sanitation facilities

Public willingness to use decentralised sanitation facilities or arising water products is discouraged due to malodour, preventing improved sanitation practices or water reuse opportunities in low income countries Whilst odour is characterised in the gas phase, it originates in the liquid phase. Consequently, controlling odour at source could prevent gas-phase partitioning and limit produced water contamination. This study therefore developed an analytical method for the quantitation of a range of liquid phase volatile organic compounds (VOCs) classified into eight chemical groups, known to be primary indicators of faecal odour, to provide characterisation of real fluids and to permit evaluation of several potential membrane separation technologies for liquid phase odourant separation. The gas chromatography mass spectrometry method provided quantitation in the range of 0.005 mg L-1 to 100 mg L-1 with instrument detection limits ranging from 0.005 mg L-1 to 0.124 mg L-1. Linear calibration curves were achieved (r2 >0.99) with acceptable accuracy (77-115%) and precision (<15%) for quantitation in the calibration range below 1 mg L 1, and good accuracy (98-104%) and precision (<2%) determined for calibration in the range 1-100 mg L-1. Pre-concentration of real samples was facilitated via solid phase extraction. Subsequent application of the method to the evaluation of two thermally driven membranes based on hydrophilic (polyvinyl alcohol) and hydrophobic (polydimethylsiloxane) polymers evidenced contrasting separation profiles. Importantly, this study demonstrates the methods utility for liquid phase VOC determination which is of use to a range of disciplines, including healthcare professionals, taste and odour specialists and public health engineers

A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia

Introduction: Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post-discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP). Methods: We held semi-structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12-week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post-discharge from a smoke-free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data. Results: cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP-facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP. Discussion and Conclusions: AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP.</p

Extension for Community Healthcare Outcomes-Palliative Care in Africa Program: Improving Access to Quality Palliative Care

Purpose: There is limited access to quality palliative care (PC) for patients with advanced cancer in sub-Saharan Africa. Our aim was to describe the development of the Project Extension for Community Healthcare Outcomes- Palliative Care in Africa (ECHO-PACA) program and describe a preliminary evaluation of attitudes and knowledge of participants regarding the ability of the program to deliver quality PC. Methods: An interdisciplinary team at the MD Anderson Cancer Center, guided by experts in PC in sub-Saharan Africa, adapted a standardized curriculum based on PC needs in the region. Participants were then recruited, and monthly telementoring sessions were held for 16 months. The monthly telementoring sessions consisted of case presentations, discussions, and didactic lectures. Program participants came from 14 clinics and teaching hospitals in Ghana, Kenya, Nigeria, South Africa, and Zambia. Participants were surveyed at the beginning, midpoint, and end of the 16-month program to evaluate changes in attitudes and knowledge of PC. Results: The median number of participants per session was 30. Thirty-three (83%) of 40 initial participants completed the feedback survey. Health care providers’ self-reported confidence in providing PC increased with participation in the Project ECHO-PACA clinic. There was significant improvement in the participants’ attitudes and knowledge, especially in titrating opioids for pain control (P = .042), appropriate use of non-opioid analgesics (P = .012), and identifying and addressing communication issues related to end-of-life care (P = .014). Conclusion: Project ECHO-PACA was a successful approach for disseminating knowledge about PC. The participants were adherent to ECHO PACA clinics and the completion of feedback surveys. Future studies should evaluate the impact of Project ECHO-PACA on changes in provider practice as well as patient outcomes

Long-Term Complications of Ebola Virus Disease: Prevalence and Predictors of Major Symptoms and the Role of Inflammation

Background Cohort studies have reported a high prevalence of musculoskeletal, neurologic, auditory, and visual complications among Ebola virus disease (EVD) survivors. However, little is known about the host- and disease-related predictors of these symptoms and their etiological mechanisms. Methods The presence and patterns of 8 cardinal symptoms that are most commonly reported following EVD survival were assessed in the 326 EVD survivors who participated in the ongoing longitudinal Liberian EVD Survivor Study. At quarterly study visits, symptoms that developed since acute EVD were recorded and blood was collected for biomarkers of inflammation and immune activation. Results At baseline (mean 408 days from acute EVD), 75.5% of survivors reported at least 1 new cardinal symptom since surviving EVD, which in 85.8% was rated as highly interfering with life. Two or more incident symptoms were reported by 61.0% of survivors, with pairings of joint pain, headache, or fatigue the most frequent. Women were significantly more likely than men to report headache, while older age was significantly associated with musculoskeletal and visual symptoms. In analyses adjusted for multiple comparisons, no statistically significant association was found between any symptom and 26 markers of inflammation and immune activation. Symptom frequency remained largely unchanged during study follow-up. Conclusions Post-EVD complications occur in a majority of survivors and remain present more than 4 years after acute infection. An association between markers of inflammation and immune activation and individual symptoms was not found, suggesting an alternative etiology for persistent post-EVD symptomatology

Development and validation of a targeted gene sequencing panel for application to disparate cancers

Next generation sequencing has revolutionised genomic studies of cancer, having facilitated the development of precision oncology treatments based on a tumour’s molecular profile. We aimed to develop a targeted gene sequencing panel for application to disparate cancer types with particular focus on tumours of the head and neck, plus test for utility in liquid biopsy. The final panel designed through Roche/Nimblegen combined 451 cancer-associated genes (2.01 Mb target region). 136 patient DNA samples were collected for performance and application testing. Panel sensitivity and precision were measured using well-characterised DNA controls (n = 47), and specificity by Sanger sequencing of the Aryl Hydrocarbon Receptor Interacting Protein (AIP) gene in 89 patients. Assessment of liquid biopsy application employed a pool of synthetic circulating tumour DNA (ctDNA). Library preparation and sequencing were conducted on Illumina-based platforms prior to analysis with our accredited (ISO15189) bioinformatics pipeline. We achieved a mean coverage of 395x, with sensitivity and specificity of >99% and precision of >97%. Liquid biopsy revealed detection to 1.25% variant allele frequency. Application to head and neck tumours/cancers resulted in detection of mutations aligned to published databases. In conclusion, we have developed an analytically-validated panel for application to cancers of disparate types with utility in liquid biopsy