Can an established preschool obesity prevention programme (HENRY) be successfully delivered by trained volunteers?

Abstract IntroductionAlmost a quarter of 4-5 year olds are overweight. HENRY (Health, Exercise, Nutrition for the Really Young) delivers evidence-based interventions with consistently positive results when delivered by trained staff. This study tested whether this intervention could also be successfully delivered by trained volunteers.MethodThe programme was delivered one-to-one over eight 1-hour sessions. Baseline and post programme data was analysed for 87 parents and, for a sub-sample, at 6 months follow-up. Delivery was at the parent's home or community venue according to parent preference in four London boroughs. Approximately 80% of programmes were delivered by volunteers with a similar demographic profile to target parents and 20% by staff to enable a comparative evaluation.ResultsProgrammes provided by volunteers and staff showed similar statistically significant improvements in self-reported parent and child emotional wellbeing, parenting efficacy, and fruit and vegetable consumption. Additional benefits were seen in family eating (e.g. eating healthy meals and eating with others) and food purchasing (e.g. reading labels on food packaging) behaviours. Follow-up data showed that some changes were maintained six months later. Parent and volunteer ratings of the programme and training were very positive, with high retention (mean attendance of 7.2 out of 8 sessions).ConclusionVolunteers from similar backgrounds to target families can be recruited and trained to deliver structured obesity prevention programmes, resulting in the same positive lifestyle changes as those delivered by paid staff. External funding details Department of Health: Health and Social Care Volunteering Fund grant (Ref: 2013/National/055).Peer reviewe

Visual needs in different occupational settings

The occupational setting is quite diverse in its visual demands. Part of the duty of the practicing optometrist is to address the visual needs of the patient and thereby provide the appropriate treatment and information to the patient to satisfy those varying visual needs for optimum vision. We surveyed four occupations concerning vision in the workplace: travel agent, physical therapist, private investigator, and paramedic. From the collected data it is very apparent that each of these occupations has a variety of visual tasks that are often associated with visual problems and, hence, this is likely in other fields of work as well. This is where the optometrist has a special place as a problem-solver. Specifically we found that progressive lenses, safety eyewear, and gas permeable contact lenses are underutilized. Also there is plenty of room for improving lighting in the workplace and reducing the amount of headaches and other common near task complaints like dry eyes. Proper communication with the patient about their occupational tasks and hobbies will better enable the optometrist to meet the varying visual needs of patients

SPEAR-1: An experiment to measure current collection in the ionosphere by high voltage biased conductors

An experiment is described in which a high electrical potential difference, up to 45 kV, was applied between deployed conducting spheres and a sounding rocket in the ionosphere. Measurements were made of the applied voltage and the resulting currents for each of 24 applications of different high potentials. In addition, diagnostic measurements of optical emissions in the vicinity of the spheres, energetic particle flow to the sounding rocket, dc electric field and wave data were made. The ambient plasma and neutral environments were measured by a Langmuir probe and a cold cathode neutral ionization gauge, respectively. The payload is described and examples of the measured current and voltage characteristics are presented. The characteristics of the measured currents are discussed in terms of the diagnostic measurements and the in-situ measurements of the vehicle environment. In general, it was found that the currents observed were at a level typical of magnetically limited currents from the ionospheric plasma for potentials less than 12 kV, and slightly higher for larger potentials. However, due to the failure to expose the plasma contactor, the vehicle sheath modified the sphere sheaths and made comparisons with the analytic models of Langmuir-Blodgett and Parker-Murphy less meaningful. Examples of localized enhancements of ambient gas density resulting from the operation of the attitude control system thrusters (cold nitrogen) were obtained. Current measurements and optical data indicated localized discharges due to enhanced gas density that reduced the vehicle-ionosphere impedance

The clinical reasoning processes of extended scope physiotherapists assessing patients with low back pain

IntroductionEmploying allied health professionals in extended scope roles has developed relatively recently in health-care. Within physiotherapy, the extended role has provided clinicians with autonomy to use knowledge and clinical acumen to request investigations such as Magnetic Resonance Imaging (MRI) and X-ray as part of the diagnostic process, a practice beyond the traditional scope of physiotherapy. In these advancing roles, little is written about the clinical reasoning processes that clinicians use in managing patients with musculoskeletal pain and knowledge of these processes would advance training for new recruits to this arena.StudyThis qualitative study has explored the processes by which extended scope physiotherapists (ESPs) clinically reason their decisions regarding patients reporting low back pain in a musculoskeletal outpatient setting. The study used a multiple case study design informed by grounded theory methodology, using focus groups (involving ESPs and non-ESPs/musculoskeletal physiotherapists) and semi-structured interviews with a think-aloud method (ESPs only) to investigate these processes.ConclusionsThe themes identified include: prior thinking; patient interaction; formal testing; time; safety and accountability; external and internal factors; and gut-feeling (which challenges current physiotherapy models of reasoning). Extended scope physiotherapists reported experiencing greater stress due to higher levels of perceived accountability, safety requirements and internal drivers for competence than non-ESPs. Further research is indicated to explore the role of gut-feeling in musculoskeletal physiotherapy clinical reasoning

Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: a systematic review and meta-analysis

There is a high prevalence of post-traumatic stress disorder (PTSD) in refugee and asylum seeker populations which can pose distinct challenges for mental health professionals. This review included 16 randomised controlled trials (RCTs) with 1111 participants investigating the effect of psychological interventions on PTSD in these populations. We searched PsychInfo, ProQuest (including selected databases ASSIA, IBSS, PILOTS), Web of Science, the Cochrane Central Database of Controlled Studies (CENTRAL) and Cochrane Database for Systematic Reviews (CDSR) to identify peer-reviewed, primary research articles up to May 2018. We used rigorous methods to assess the quality of included trials and evidence using Cochrane, SURE and GRADE systems. 525 trials were reviewed, 16 were included with 15 contributed to meta-analyses. Despite the challenges of conducting research in this field we found evidence for trauma-focused psychological interventions for PTSD in this population. Following sub-group analyses, we found evidence to support the use of EMDR and Narrative Exposure Therapy for PTSD symptoms. We considered these findings in relation to the broader PTSD treatment literature and related literature from survivors of large scale conflict. These findings suggest that trauma focused psychological therapies can be effective in improving symptoms for refugees and asylum seekers with PTSD

Active duty and ex-serving military personnel with post-traumatic stress disorder treated with psychological therapies: systematic review and meta-analysis

Background: Post-traumatic stress disorder (PTSD) is a major cause of morbidity amongst active duty and ex-serving military personnel. In recent years increasing efforts have been made to develop more effective treatments. Objective: To determine which psychological therapies are efficacious in treating active duty and ex-serving military personnel with post-traumatic stress disorder (PTSD). Method: A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measure was reduction in PTSD symptoms and the secondary outcome dropout. Results: Twenty-four studies with 2386 participants were included. Evidence demonstrated that CBT with a trauma focus (CBT-TF) was associated with the largest evidence of effect when compared to waitlist/usual care in reducing PTSD symptoms post treatment (10 studies; n = 524; SMD −1.22, −1.78 to −0.66). Group CBT-TF was less effective when compared to individual CBT-TF at reducing PTSD symptoms post treatment (1 study; n = 268; SMD −0.35, −0.11 to −0.59). Eye Movement Desensitization and Reprocessing (EMDR) therapy was not effective when compared to waitlist/usual care at reducing PTSD symptoms post treatment (4 studies; n = 92; SMD −0.83, −1.75 to 0.10). There was evidence of greater dropout from CBT-TF therapies compared to waitlist and Present Centred Therapy. Conclusions: The evidence, albeit limited, supports individual CBT-TF as the first-line psychological treatment of PTSD in active duty and ex-serving personnel. There is evidence for Group CBT-TF, but this is not as strong as for individual CBT-TF. EMDR cannot be recommended as a first line therapy at present and urgently requires further evaluation. Lower effect sizes than for other populations with PTSD and high levels of drop-out suggest that CBT-TF in its current formats is not optimally acceptable and further research is required to develop and evaluate more effective treatments for PTSD and complex PTSD in active duty and ex-serving military personnel

A Comparative Magnetic Resonance Imaging Study of the Anatomy, Variability, and Asymmetry of Broca's Area in the Human and Chimpanzee Brain

The frontal operculum—classically considered to be Broca's area—has special significance and interest in clinical, cognitive, and comparative neuroscience given its role in spoken language and the long-held assumption that structural asymmetry of this region of cortex may be related to functional lateralization of human language. We performed a detailed morphological and morphometric analysis of this area of the brain in humans and chimpanzees using identical image acquisition parameters, image analysis techniques, and consistent anatomical boundaries in both species. We report great inter-individual variability of the sulcal contours defining the operculum in both species, particularly discontinuity of the inferior frontal sulcus in humans and bifurcation of the inferior precentral sulcus in chimpanzees. There was no evidence of population-based asymmetry of the frontal opercular gray matter in humans or chimpanzees. The diagonal sulcus was only identified in humans, and its presence was significantly (F = 12.782, p < 0.001) associated with total volume of the ipsilateral operculum. The findings presented here suggest that there is no population-based interhemispheric macroscopic asymmetry of Broca's area in humans or Broca's area homolog in chimpanzees. However, given that previous studies have reported asymmetry in the cytoarchitectonic fields considered to represent Broca's area—which is important given that cytoarchitectonic boundaries are more closely related to the regional functional properties of cortex relative to sulcal landmarks—it may be that the gross morphology of the frontal operculum is not a reliable indicator of Broca's area per se