Predictors of Adherence to a Structured Exercise Program and Physical Activity Participation in Community Dwellers after Stroke

Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult

Predictors of Adherence to a Structured Exercise Program and Physical Activity Participation in Community Dwellers after Stroke

Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult

Host Agency Perspectives on Facilitating Community-Based Clinical Experiences for Nursing Students

Nurse educators have developed many innovations for nursing education in response to the current shortage of clinical placements. Nursing programs are increasingly relying on placements in community-based agencies (some of which are not health agencies) and university-agency collaborations are being developed to enhance capacity for student placements. Our interest in this qualitative study was to elicit the perspectives of host agencies in these alternate sites regarding hosting undergraduate student clinical placements. Aims were to gain insight about (1) how community-based host agencies decide to host students, including how the number of students hosted is determined; (2) the nature of agency-university partnerships; and (3) the agency’s experiences of hosting students in relation to benefits and issues that accompany hosting students. Administrators from twenty-five community-based agencies that hosted undergraduate nursing students from the researchers’ university were invited to participate in an online survey or telephone interview, with a final sample size of eighteen respondents. Each participant was given the option of a telephone interview but most elected to complete the online survey because of its flexibility; five participants were interviewed on the phone and 13 completed the open-ended survey questions online. Findings revealed that host agency decisions to host students could have an ad hoc nature to them, and were described as contingent on various explicit and implicit factors such as staff availability, the perceived contribution of students, or a philosophic commitment to contribute to student education. Smaller agencies reported and preferred informal partnerships with the educational institutions because they were perceived to be more flexible, and all sites emphasized the need for increased, improved communication with clinical instructors and more direct supervision of student placements by the educational unit. The benefits of hosting student nurses were described as outweighing the issues and challenges. The study also revealed incongruities between the perspectives of these host agencies and typically-held views of nursing programs, whereby host agencies spoke of the “ideal student” and nursing programs tend to seek an “ideal placement”. Further research is needed to generate knowledge about expanding capacity for clinical placements, enhancing partnerships, and enriching student learning outcomes. Résumé Compte tenu de la pénurie de places de stages cliniques, les professeures en sciences infirmières ont développé plusieurs innovations en formation infirmière. Les programmes de sciences infirmières comptent de plus en plus sur les stages au sein d’organismes communautaires (certains ne sont pas des organismes de santé) et les universités favorisent des partenariats avec ces organismes afin d’accroître la capacité d’accueil de stagiaires. Cette étude qualitative visait à décrire les perspectives d’organismes hôtes dans ces sites alternatifs concernant l’accueil d’étudiantes de premier cycle dans le cadre de stages cliniques. Les objectifs étaient de mieux comprendre : (1) comment les organismes communautaires hôtes prennent la décision d’accueillir des étudiantes dans le cadre de stages cliniques et comment ils déterminent le nombre d’étudiantes qui seront accueillies; (2) la nature des partenariats organisme-université; et (3) les expériences de l’organisme en ce qui concerne l’accueil des étudiantes, plus particulièrement les avantages et les problèmes liés à l’accueil des étudiantes. Des administrateurs de vingt-cinq organismes communautaires, qui ont accueilli des étudiantes en sciences infirmières de l’université d’attache des chercheurs, ont été invités à participer à un sondage en ligne ou à une entrevue téléphonique. La taille de l’échantillon final était de dix-huit participants. La plupart des participants ont opté pour le sondage en ligne à cause de sa flexibilité; cinq participants ont répondu à une entrevue téléphonique et treize ont complété le sondage en ligne qui comportait des questions ouvertes. Les résultats indiquent que les organismes hôtes décident d’accueillir des étudiantes en stage afin de répondre à des besoins spécifiques, et la décision dépend de plusieurs facteurs explicites et implicites, tels que la disponibilité du personnel, la perception de la contribution des étudiantes, ou un engagement philosophique à contribuer à la formation d’étudiantes. Les plus petits organismes ont indiqué qu’ils préfèrent les partenariats informels avec les établissements de formation car ils les perçoivent comme étant plus souples. Tous les sites ont souligné le besoin de communications plus fréquentes et améliorées avec les enseignantes cliniques et de supervision plus directe des stages des étudiantes par l’unité d’enseignement. Les avantages d’accueillir des étudiantes étaient décrits par les organismes hôtes comme dépassant les inconvénients ou les défis. L’étude a aussi révélé des incongruités entre les perspectives des organismes hôtes et celles des programmes de sciences infirmières : les organismes hôtes décrivent ce que serait un « étudiante idéale» et les programmes de sciences infirmières souhaitent trouver le « stage idéal ». D’autres recherches seront nécessaires afin de générer des connaissances sur l’augmentation de la capacité d’accueil de stagiaires, l’amélioration des partenariats, et l’enrichissement des résultats d’apprentissage des étudiantes

Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial

Background: Stroke is the most common disabling neurological condition in adults. Falls and poor mobility are major contributors to stroke-related disability. Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population. Currently there is good evidence that exercise can enhance mobility after stroke, yet ongoing exercise programs for general community-based stroke survivors are not routinely available. This randomised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors. Methods and design: Three hundred and fifty community dwelling stroke survivors will be recruited. Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessments and exercise program. After the completion of the pre-test assessment, participants will be randomly allocated to one of two intervention groups. Both intervention groups will participate in weekly group-based exercises and a home program for twelve months. In the lower limb intervention group, individualised programs of weight-bearing balance and strengthening exercises will be prescribed. The upper limb/cognition group will receive exercises aimed at management and improvement of function of the affected upper limb and cognition carried out in the seated position. The primary outcome measures will be falls (measured with 12 month calendars) and mobility. Secondary outcome measures will be risk of falling, physical activity levels, community participation, quality of life, health service utilisation, upper limb function and cognition. Discussion: This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors. We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke. This program, if found to be effective, has the potential to be implemented within existing community services. Trial registration: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12606000479505)

Interventions for improving the design and conduct of scientific research: A scoping review protocol [version 2; peer review: 2 approved]

Background Research waste is prevalent in many scientific fields despite a number of initiatives to improve research practices. Interventions to improve practice are often implemented without evaluating their effectiveness. It is therefore important to identify the interventions that have been evaluated, assess how they have been evaluated and to identify areas where further research is required. Objectives A scoping review will be undertaken to assess what interventions, aimed at researchers or research teams, to improve research design and conduct have been evaluated. This review will also consider when in the research pathway these interventions are implemented; what aspects of research design or conduct are being targeted; and who is implementing these interventions. Methods Interventions which aim to improve the design or conduct of research will be eligible for inclusion. The review will not include interventions aimed at hypothetical research projects or interventions implemented without evaluation. The following sources will be searched: MEDLINE, EMBASE, ERIC, HMIC, EconLit, Social Policy and Practice, ProQuest theses, and MetaArXiv. Hand searching of references and citations of included studies will also be undertaken. Searches will be limited to articles published in the last 10 years. Data extraction will be completed using a data extraction template developed for this review.  Results will be tabulated by type of intervention, research stage, and outcome. A narrative review will also be provided addressing each of the objectives

A combined geomorphological and geophysical approach to characterising relict landslide hazard on the Jurassic Escarpments of Great Britain

The Jurassic Escarpment in the North York Moors in Northern Britain has a high density of deep-seated relict landslides but their regional hazard is poorly understood due to a lack of detailed case studies. Investigation of a typical relict landslide at Great Fryup Dale suggests that the crop of the Whitby Mudstone Formation is highly susceptible to landslide hazards. The mudstone lithologies along the Escarpment form large multiple rotational failures which break down at an accelerated rate during wetter climates and degrade into extensive frontal mudflows. Geomorphological mapping, high resolution LiDAR imagery, boreholes, and geophysical ERT surveys are deployed in a combined approach to delimit internal architecture of the landslide. Cross-sections developed from these data indicate that the main movement displaced a bedrock volume of c. 1 × 107 m3 with a maximum depth of rupture of c. 50 m. The mode of failure is strongly controlled by lithology, bedding, joint pattern, and rate of lateral unloading. Dating of buried peats using the AMS method suggests that the 10 m thick frontal mudflow complex was last active in the Late Holocene, after c. 2270 ± 30 calendar years BP. Geomorphic mapping and dating work indicates that the landslide is dormant, but slope stability modelling suggests that the slope is less stable than previously assumed; implying that this and other similar landslides in Britain may become more susceptible to reactivation or extension during future wetter climatic phases. This study shows the value of a multi-technique approach for landslide hazard assessment and to enhance national landslide inventories

Neural stem cells express melatonin receptors and neurotrophic factors: colocalization of the MT(1 )receptor with neuronal and glial markers

BACKGROUND: In order to optimize the potential benefits of neural stem cell (NSC) transplantation for the treatment of neurodegenerative disorders, it is necessary to understand their biological characteristics. Although neurotrophin transduction strategies are promising, alternative approaches such as the modulation of intrinsic neurotrophin expression by NSCs, could also be beneficial. Therefore, utilizing the C17.2 neural stem cell line, we have examined the expression of selected neurotrophic factors under different in vitro conditions. In view of recent evidence suggesting a role for the pineal hormone melatonin in vertebrate development, it was also of interest to determine whether its G protein-coupled MT(1 )and MT(2 )receptors are expressed in NSCs. RESULTS: RT-PCR analysis revealed robust expression of glial cell-line derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in undifferentiated cells maintained for two days in culture. After one week, differentiating cells continued to exhibit high expression of BDNF and NGF, but GDNF expression was lower or absent, depending on the culture conditions utilized. Melatonin MT(1 )receptor mRNA was detected in NSCs maintained for two days in culture, but the MT(2 )receptor was not seen. An immature MT(1 )receptor of about 30 kDa was detected by western blotting in NSCs cultured for two days, whereas a mature receptor of about 40 – 45 kDa was present in cells maintained for longer periods. Immunocytochemical studies demonstrated that the MT(1 )receptor is expressed in both neural (β-tubulin III positive) and glial (GFAP positive) progenitor cells. An examination of the effects of melatonin on neurotrophin expression revealed that low physiological concentrations of this hormone caused a significant induction of GDNF mRNA expression in NSCs following treatment for 24 hours. CONCLUSIONS: The phenotypic characteristics of C17.2 cells suggest that they are a heterogeneous population of NSCs including both neural and glial progenitors, as observed under the cell culture conditions used in this study. These NSCs have an intrinsic ability to express neurotrophic factors, with an apparent suppression of GDNF expression after several days in culture. The detection of melatonin receptors in neural stem/progenitor cells suggests involvement of this pleiotropic hormone in mammalian neurodevelopment. Moreover, the ability of melatonin to induce GDNF expression in C17.2 cells supports a functional role for the MT(1 )receptor expressed in these NSCs. In view of the potency of GDNF in promoting the survival of dopaminergic neurons, these novel findings have implications for the utilization of melatonin in neuroprotective strategies, especially in Parkinson's disease