Central Modulation of Postural Control in Response to Task Demands and Fatigue in Individuals with and without a History of Low Back Pain

Background During voluntary limb movement, feedforward postural activation of the trunk and hip musculature occurs to maintain postural stability. This is called an anticipatory postural adjustment (APA). Onset of trunk muscle APAs is delayed in symptomatic individuals with persistent low back pain (LBP). It is not clear how spatial APA organization is affected, or if adaptations in APAs persist between symptomatic episodes. We used two versions of a supine active leg raise task to examine central modulation of APAs. One version of the task, the supported leg raise (SLR) does not elicit trunk/hip APAs. The other, the unsupported leg raise (ULR) elicits APAs in the bilateral abdominals and in the hip musculature contralateral to the moving limb. We hypothesized that individuals with a history of LBP would demonstrate increased amplitude of APA activation in non-fatigued muscles following fatiguing exercise. Methods 40 right-limb dominant adults between the ages of 18 to 35 years participated. The LBP group (n = 25) had a greater than one-year history of functionally limiting low back pain but were in symptom remission at the time of the data collection. The back healthy control group (n = 15) had no history of back pain. Surface electromyography electrodes were placed bilaterally on the internal obliques (IO), external obliques (EO), biceps femoris (HS) and rectus femoris muscles. Ten repetitions of the SLR and the ULR were performed before and after paraspinal fatigue was induced by the isometric Biering-Sorensen endurance test. For the SLR, participants lay supine with the left upper leg supported and extended the knee to touch the ankle to a target. For the ULR, participants raised the entire leg to touch the ankle to the target. The ULR was performed both at self-selected speed and as fast as possible following an auditory cue. Root mean square amplitude of the APAs and speed of task performance (raise time) was calculated. Mixed model ANOVA were used to test for main effects of task (5 levels, SLR, ULR SLOW and FAST pre-fatigue, ULR SLOW and FAST post-fatigue) and group and task*group interactions. Results Raise time was faster for the ULR FAST than the ULR SLOW. Raise time did not differ between groups and remained the same post-fatigue. For all muscles, APA amplitude increased with task difficulty and with task speed. For right and left EO there was a significant task*group interaction. For both muscles, amplitude of activity increased for ULR FAST pre-fatigue, but this speed-dependent increase in amplitude did not occur in the LBP group post-fatigue. Conclusion Central modulation of APAs in non-fatigued muscles occurs in response to fatiguing exercise. This likely facilitates maintenance of postural stability and task performance. The ability to modulate abdominal muscle APAs in response to fatigue and task demands is impaired in young adults with a history of LBP even during symptom remission

The Effects of a College Human Sexuality Course on Students' Sexual Knowledge, Attitude, and Behavior.

Using an experimental-comparison group design, data were collected at the beginning and end of a semester to assess the effect of a human sexuality course on students' sexual knowledge, sexual attitude, and sexual behaviors. Data analysis by t-tests showed statistical differences between the experimental and comparison group only on sexual knowledge scores ( p < .001), with the experimental group scoring higher. T-tests showed statistical difference between males and females in sexual attitude (p< .001) and sexual behavior (p< .001) with women scoring higher than men in the experimental group, and also when experimental and control groups were combined. Although not statistically significant, women scored higher in sexual knowledge than males

Using the Plan-Do-Study-Act (PDSA) Model for Continuous Quality Improvement of an Established Simulated Patient Program

Objective: To describe the use of a continuous quality improvement process for strengthening our simulated patient (SP) program and the initial steps that have been implemented.&nbsp; Innovation: A workgroup that included five clinical faculty with significant experience working with SPs and a strong interest in improving the SP program was developed.&nbsp; The Plan-Do-Study-Act model was used as it allowed for incremental quality improvement changes, in order to ensure a high-quality SP program designed to optimize student learning.&nbsp; Data were gathered from students, SPs, and faculty. Opportunities for improvement were prioritized based on anticipated benefits and available resources.&nbsp; Changes related to planning, implementation, and evaluation and feedback have been executed. Critical Analysis: Changes related to planning that were implemented included developing handbooks for SPs, faculty, and graduate student instructors, as well as material for students in order to better describe the program.&nbsp; SPs are now referred to as “simulated” as opposed to “standardized” as part of a broader effort to clarify the purpose of SP interactions to students.&nbsp; Streamlined rubrics have been piloted, including electronic rubrics for first year students.&nbsp; SPs are being trained on fewer cases, in order to improve the training program.&nbsp; When possible, activities now take place in one large classroom instead of many small classrooms to improve oversight.&nbsp; Finally, additional feedback has been obtained from SPs via a retreat.&nbsp; These changes have been well received by students, SPs, and faculty.&nbsp;&nbsp;&nbsp; Next Steps: The collection of this data and initial quality improvement changes provided a basis for hiring a full-time employee who will: dedicate 50% of their time to programmatic assessment of the SP program, support faculty with logistics and training, and be the face of our program to the students and SPs. Further, formal quantitative and qualitative assessment of the SP program has begun. &nbsp; Type:&nbsp; Not

Open science in archaeology

No abstract available

Mathematical modeling of ovine footrot in the UK: the effect of Dichelobacter nodosus and Fusobacterium necrophorum on the disease dynamics

Dichelobacter nodosus is a virulent, invasive, anaerobic bacterium that is believed to be the causative agent of ovine footrot, an infectious bacterial disease of sheep that causes lameness. Another anaerobe, Fusobacterium necrophorum, has been intimately linked with the disease occurrence and severity. Here we examine data from a longitudinal study of footrot on one UK farm, including quantitative PCR (qPCR) estimates of bacterial load of D. nodosus and F. necrophorum. The data is at foot level; all feet were monitored for five weeks assessing disease severity (healthy, interdigital dermatitis (ID), or severe footrot (SFR)) and bacterial load (number of bacteria/swab). We investigate the role of D. nodosus and F. necrophorum in the progress of the disease using a continuous-time Markov model with 12 different states characterising the foot. The transition rates between the adjacent states are the (34) model parameters, these are determined using Metropolis Hasting MCMC. Our aim is to determine the predictive relationship between past and future D. nodosus and F. necrophorum load and disease states. We demonstrate a high level of predictive accuracy at the population level for the D. nodosus model, although the dynamics of individual feet is highly stochastic. However, we note that this predictive accuracy at population level is only high in more diseased states for F. necrophorum model. This supports our hypothesis that D. nodosus load and status of the foot work in combination to give rise to severe footrot and lameness, and that D. nodosus load plays the primary role in the initiation and progression of footrot, while F. necrophorum load rather increases disease severity of SFR

Integrated management of HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-AFRICA): a pragmatic cluster-randomised, controlled trial

BACKGROUND: In sub-Saharan Africa, health-care provision for chronic conditions is fragmented. The aim of this study was to determine whether integrated management of HIV, diabetes, and hypertension led to improved rates of retention in care for people with diabetes or hypertension without adversely affecting rates of HIV viral suppression among people with HIV when compared to standard vertical care in medium and large health facilities in Uganda and Tanzania. METHODS: In INTE-AFRICA, a pragmatic cluster-randomised, controlled trial, we randomly allocated primary health-care facilities in Uganda and Tanzania to provide either integrated care or standard care for HIV, diabetes, and hypertension. Random allocation (1:1) was stratified by location, infrastructure level, and by country, with a permuted block randomisation method. In the integrated care group, participants with HIV, diabetes, or hypertension were managed by the same health-care workers, used the same pharmacy, had similarly designed medical records, shared the same registration and waiting areas, and had an integrated laboratory service. In the standard care group, these services were delivered vertically for each condition. Patients were eligible to join the trial if they were living with confirmed HIV, diabetes, or hypertension, were aged 18 years or older, were living within the catchment population area of the health facility, and were likely to remain in the catchment population for 6 months. The coprimary outcomes, retention in care (attending a clinic within the last 6 months of study follow-up) for participants with either diabetes or hypertension (tested for superiority) and plasma viral load suppression for those with HIV (>1000 copies per mL; tested for non-inferiority, 10% margin), were analysed using generalised estimating equations in the intention-to-treat population. This trial is registered with ISCRTN 43896688. FINDINGS: Between June 30, 2020, and April 1, 2021 we randomly allocated 32 health facilities (17 in Uganda and 15 in Tanzania) with 7028 eligible participants to the integrated care or the standard care groups. Among participants with diabetes, hypertension, or both, 2298 (75·8%) of 3032 were female and 734 (24·2%) of 3032 were male. Of participants with HIV alone, 2365 (70·3%) of 3365 were female and 1000 (29·7%) of 3365 were male. Follow-up lasted for 12 months. Among participants with diabetes, hypertension, or both, the proportion alive and retained in care at study end was 1254 (89·0%) of 1409 in integrated care and 1457 (89·8%) of 1623 in standard care. The risk differences were -0·65% (95% CI -5·76 to 4·46; p=0·80) unadjusted and -0·60% (-5·46 to 4·26; p=0·81) adjusted. Among participants with HIV, the proportion who had a plasma viral load of less than 1000 copies per mL was 1412 (97·0%) of 1456 in integrated care and 1451 (97·3%) of 1491 in standard care. The differences were -0·37% (one-sided 95% CI -1·99 to 1·26; pnon-inferiority<0·0001 unadjusted) and -0·36% (-1·99 to 1·28; pnon-inferiority<0·0001 adjusted). INTERPRETATION: In sub-Saharan Africa, integrated chronic care services could achieve a high standard of care for people with diabetes or hypertension without adversely affecting outcomes for people with HIV. FUNDING: European Union Horizon 2020 and Global Alliance for Chronic Diseases

Current knowledge, status and future for plant and fungal diversity in Great Britain and the UK Overseas Territories

Societal Impact Statement We rely on plants and fungi for most aspects of our lives. Yet plants and fungi are under threat, and we risk losing species before we know their identity, roles, and potential uses. Knowing names, distributions, and threats are first steps toward effective conservation action. Accessible products like field guides and online resources engage society, harnessing collective support for conservation. Here, we review current knowledge of the plants and fungi of the UK and UK Overseas Territories, highlighting gaps to help direct future research efforts toward conserving these vital elements of biodiversity. Summary This review summarizes current knowledge of the status and threats to the plants and fungi of Great Britain and the UK Overseas Territories (UKOTs). Although the body of knowledge is considerable, the distribution of information varies substantially, and we highlight knowledge gaps. The UK vascular flora is the most well studied and we have a relatively clear picture of its 9,001 native and alien taxa. We have seedbanked 72% of the native and archaeophyte angiosperm taxa and 78% of threatened taxa. Knowledge of the UKOTs flora varies across territories and we report a UKOTs flora comprising 4,093 native and alien taxa. We have conserved 27% of the native flora and 51% of the threatened vascular plants in Kew's Millennium Seed Bank, UK. We need a better understanding of the conservation status of plants in the wild, and progress toward completion or updating national red lists varies. Site‐based protection of key plant assemblages is outlined, and progress in identifying Important Plant Areas analyzed. Knowledge of the non‐vascular flora, especially seaweeds remains patchy, particularly in many UKOTs. The biggest gaps overall are in fungi, particularly non‐lichenized fungi. Considerable investment is needed to fill these knowledge gaps and instigate effective conservation strategies