E-survey of current international physiotherapy practice for children with ataxia following surgical resection of posterior fossa tumour.

ObjectiveTo determine current international practice regarding physiotherapy input for children with ataxia following surgery for posterior fossa tumour. Design: An e-survey covering the following domains: participant demographics, treatment/ intervention, virtual training, intensity/timing of treatment, and aims and outcomes of physiotherapy management.ParticipantsPhysiotherapists involved in the management of children with ataxia following surgical resection of posterior fossa tumour. Participants were contacted via 6 key groups; Paediatric Oncology Physiotherapy Network (POPs), Association of Paediatric Chartered Physiotherapists (APCP), European Paediatric Neurology Society (EPNS), International Society of Paediatric Oncology (SIOP)-Europe Brain Tumour Group, Posterior Fossa Society (PFS), and Pediatric Oncology Special Interest Group (SIG) (American Physical Therapy Association).ResultsA total of 96 physiotherapists participated: UK (n =53), rest of Europe (n = 23), USA/ Canada (n = 10), and Australia/NZ (n = 10). The most common physiotherapy interventions used were balance exercises, gait re-education and proximal control activities. The most frequently used adjuncts to treatment were mobility aids and orthotics. Challenges reported regarding physiotherapy treatment were: reduced availability of physiotherapy input following discharge from the acute setting, lack of evidence, impact of adjuvant oncology treatment, and psychosocial impact.ConclusionThis e-survey provides an initial scoping review of international physiotherapy practice in this area. It establishes a foundation for future research on improving rehabilitation of ataxia in this population

A Scoping Review Protocol to Map Empirical Evidence that Illuminates the Dark Side of Occupations Among Adults

The objective of this review is to explore existing literature to identify, map, and synthesise past accounts of occupations that could be considered as constituting the dark side of occupation and which could, consequently, be identified and discussed as such. Presenting findings through use of a synthesis matrix, and formulating a descriptive account of the types of occupations (including their form, function, meaning, and contribution to identity and becoming) that constitute the dark side of occupation, is anticipated to assist with prioritising future collaborative research endeavours, as part of an intended programme of research. Specifically, the review questions are: What past accounts of occupations have been discussed or explored in the literature that would constitute falling under the conceptual ‘umbrella’ of the dark side of occupation? What specific occupations that challenge the pervasive belief in the link between health and occupation have been discussed for the adult population, across all cultures? Where do gaps of knowledge remain regarding the less explored occupations people subjectively experience, and which indicate the priority research areas that need to be explored from an occupational perspective

Spatial Variation in Distribution and Growth Patterns of Old Growth Strip-Bark Pines

Postindustrial rises in CO2 have the potential to confound the interpretation of climatically sensitive tree-ring chronologies. Increased growth rates observed during the 20th century in strip-bark trees have been attributed to CO2 fertilization. Absent in the debate of CO2 effects on tree growth are spatially explicit analyses that examine the proximate mechanisms that lead to changes in rates of tree growth. Twenty-seven pairs of strip-bark and companion entire-bark trees were analyzed in a spatially explicit framework for abiotic environmental correlates. The strip-bark tree locations were not random but correlated to an abiotic proxy for soil moisture. The strip-bark trees showed a characteristic increase in growth rates after about 1875. Furthermore, the difference in growth rates between the strip-bark trees and entire-bark companions increased with increasing soil moisture. A possible mechanism for these findings is that CO2 is affecting water-use efficiency, which in turn affects tree-ring growth. These results point to the importance of accounting for microsite variability in analyzing the potential role of CO2 in governing growth responses

Ataxia and mobility in children following surgical resection of posterior fossa tumour: A longitudinal cohort study

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Development, feasibility, acceptability and potential effectiveness of a healthy lifestyle programme delivered in churches in urban and rural South Africa

Rising levels of obesity in South Africa require innovation in community-level lifestyle change programmes. Our aim was to co-develop Impilo neZenkolo (‘Health through Faith’), a healthy lifestyle programme for low-income, black South Africans delivered through churches, and evaluate its feasibility, acceptability and potential effectiveness. In the first phase we developed programme materials with church members. In the second phase we trained lay leaders to deliver the programme and assessed feasibility, acceptability (observation, focus groups and interviews) and potential effectiveness (pre and post measurement of weight, hip and waist circumferences, blood pressure, self-reported physical activity, dietary habits, health status, self-esteem, psychological distress). The study was conducted in four churches in urban and rural South Africa. The development workshops led to increased focus on positive benefits of participation, widening inclusion criteria to all adults and greater emphasis on Christian ethos. Challenges to feasibility included: recruitment of churches; scheduling of programme sessions (leading to one church not delivering the programme); attendance at the programme (63% attended more than half of the 12 weekly sessions); and poor programme fidelity (in particular in teaching behaviour change techniques). Aspects of the programme were acceptable, particularly the way in which the programme was aligned with a Christian ethos. There was some indication that amongst the 42/68 (62%) for whom we were obtained pre- and post-programme measurements the programme has potential to support weight loss. We conclude that a healthy lifestyle programme for low-income, black South Africans, delivered through churches, may be viable with extensive re-development of delivery strategies. These include finding external funding for the programme, endorsement from national level denominational organisations and the professionalization of programme leadership, including paid rather than volunteer leaders to ensure sufficient time can be spent in training

Climatic Controls on the Snowmelt Hydrology of the Northern Rocky Mountains

The northern Rocky Mountains (NRMs) are a critical headwaters region with the majority of water resources originating from mountain snowpack. Observations showing declines in western U.S. snowpack have implications for water resources and biophysical processes in high-mountain environments. This study investigates oceanic and atmospheric controls underlying changes in timing, variability, and trends documented across the entire hydroclimatic-monitoring system within critical NRM watersheds. Analyses were conducted using records from 25 snow telemetry (SNOTEL) stations, 148 1 April snow course records, stream gauge records from 14 relatively unimpaired rivers, and 37 valley meteorological stations. Over the past four decades, midelevation SNOTEL records show a tendency toward decreased snowpack with peak snow water equivalent (SWE) arriving and melting out earlier. Temperature records show significant seasonal and annual decreases in the number of frost days (days ≤0°C) and changes in spring minimum temperatures that correspond with atmospheric circulation changes and surface–albedo feedbacks in March and April. Warmer spring temperatures coupled with increases in mean and variance of spring precipitation correspond strongly to earlier snowmeltout, an increased number of snow-free days, and observed changes in streamflow timing and discharge. The majority of the variability in peak and total annual snowpack and streamflow, however, is explained by season-dependent interannual-to-interdecadal changes in atmospheric circulation associated with Pacific Ocean sea surface temperatures. Over recent decades, increased spring precipitation appears to be buffering NRM total annual streamflow from what would otherwise be greater snow-related declines in hydrologic yield. Results have important implications for ecosystems, water resources, and long-lead-forecasting capabilities

Management of the ataxias : towards best clinical practice

This document aims to provide recommendations for healthcare professionals on the diagnosis and management of people with progressive ataxia. The progressive ataxias are rare neurological conditions, and are often poorly understood by healthcare professionals. Diagnosis has generally been a long process because of the rarity and complexity of the different ataxias1. In addition, many healthcare professionals are unsure how best to manage the conditions and there is sometimes a feeling that little can be done for these patients1,2 Although there are no disease-modifying treatments for the majority of the progressive ataxias, there are many aspects of the conditions that are treatable and it is thus important that this is recognised by the relevant healthcare professionals. The diagnosis and management of the few treatable causes is also of paramount importance. All this highlights the importance of producing these guidelines: in order to increase awareness and understanding of these conditions, and lead to their improved diagnosis and management. With new developments in genetic technologies and the discovery of more genes, diagnosis is improving and has great scope to continue to do so. In addition, research is advancing and many human trials to test medications are taking place, making us more optimistic that disease-modifying treatments will be found for the progressive ataxias

Scenario planning: the future of the cattle and sheep industries in Scotland and their resiliency to disease

In this paper, we present a description of foresighting activities undertaken by EPIC, Scotland’s Centre of Expertise on Animal Disease Outbreaks, to investigate the future uncertainty of animal health security in the Scottish sheep and cattle sectors. Using scenario planning methodologies, we explored four plausible but provocative long-term futures which identify dynamics underpinning the resilience of these agricultural sectors to animal disease. These scenarios highlight a number of important drivers that influence disease resilience: industry demographics, the role of government support and regulation and the capacity for technological innovation to support the industry to meet local and global market demand. Participants in the scenario planning exercises proposed creative, robust strategies that policy makers could consider implementing now to enhance disease control and industry resilience in multiple, uncertain futures. Using these participant-led strategies as a starting point, we offer ten key questions for policy makers and stakeholders to provoke further discussion about improving resiliency and disease preparedness. We conclude with a brief discussion of the value of scenario planning, not only for the development of futures which will inform disease contingency plans and improve industry resilience, but as a mechanism for dialogue and information sharing between stakeholders and government

Identifying a Safe and Just Corridor for People and the Planet

Keeping the Earth system in a stable and resilient state, to safeguard Earth's life support systems while ensuring that Earth's benefits, risks, and related responsibilities are equitably shared, constitutes the grand challenge for human development in the Anthropocene. Here, we describe a framework that the recently formed Earth Commission will use to define and quantify target ranges for a “safe and just corridor” that meets these goals. Although “safe” and “just” Earth system targets are interrelated, we see safe as primarily referring to a stable Earth system and just targets as being associated with meeting human needs and reducing exposure to risks. To align safe and just dimensions, we propose to address the equity dimensions of each safe target for Earth system regulating systems and processes. The more stringent of the safe or just target ranges then defines the corridor. Identifying levers of social transformation aimed at meeting the safe and just targets and challenges associated with translating the corridor to actors at multiple scales present scope for future work

Identifying a Safe and Just Corridor for People and the Planet

Keeping the Earth system in a stable and resilient state, to safeguard Earth's life support systems while ensuring that Earth's benefits, risks, and related responsibilities are equitably shared, constitutes the grand challenge for human development in the Anthropocene. Here, we describe a framework that the recently formed Earth Commission will use to define and quantify target ranges for a “safe and just corridor” that meets these goals. Although “safe” and “just” Earth system targets are interrelated, we see safe as primarily referring to a stable Earth system and just targets as being associated with meeting human needs and reducing exposure to risks. To align safe and just dimensions, we propose to address the equity dimensions of each safe target for Earth system regulating systems and processes. The more stringent of the safe or just target ranges then defines the corridor. Identifying levers of social transformation aimed at meeting the safe and just targets and challenges associated with translating the corridor to actors at multiple scales present scope for future work