Activity-Based Therapy in a Community Setting for Independence, Mobility, and Sitting Balance for People With Spinal Cord Injuries.

Introduction: Activity-based therapy (ABT) aims to activate the neuromuscular system below the level of the spinal cord lesion and promote recovery of motor tasks through spinal reorganisation, motor learning and changes to muscles and sensory system. We investigated the effects of a multimodal ABT program on mobility, independence and sitting balance in individuals with spinal cord injury (SCI). Methods: Retrospective clinical data from 91 adults who independently enrolled in four community-based ABT centres in Australia were analysed. The multimodal ABT program was delivered for 3 to 12 months, one to four times per week. Assessments were undertaken every 3 months and included the Modified Rivermead Mobility Index (MRMI), Spinal Cord Independence Measure (SCIM) and seated reach distance (SRD). A linear mixed model analysis was used to determine time-based and other predictors of change. Results: There was a significant improvement after 12 months for all outcome measures, with a mean change score of 4 points in the SCIM (95% confidence interval [CI]: 2.7-5.3, d = 0.19), 2 points in the MRMI (95% CI: 1-2.3, d = 0.19) and 0.2 in the SRD (95% CI: 0.1-2.2, d = 0.52). Greater improvements occurred in the first 3 months of intervention. There were no interaction effects between time and the neurological level of injury, American Spinal Injury Association Impairment Scale classification, or duration post-injury for most outcomes. Conclusions: A community-based ABT exercise program for people with SCI can lead to small improvements in mobility, independence and balance in sitting, with greater improvements occurring early during intervention

Malaria risk in young male travellers but local transmission persists: a case-control study in low transmission Namibia.

BACKGROUND: A key component of malaria elimination campaigns is the identification and targeting of high risk populations. To characterize high risk populations in north central Namibia, a prospective health facility-based case-control study was conducted from December 2012-July 2014. Cases (n = 107) were all patients presenting to any of the 46 health clinics located in the study districts with a confirmed Plasmodium infection by multi-species rapid diagnostic test (RDT). Population controls (n = 679) for each district were RDT negative individuals residing within a household that was randomly selected from a census listing using a two-stage sampling procedure. Demographic, travel, socio-economic, behavioural, climate and vegetation data were also collected. Spatial patterns of malaria risk were analysed. Multivariate logistic regression was used to identify risk factors for malaria. RESULTS: Malaria risk was observed to cluster along the border with Angola, and travel patterns among cases were comparatively restricted to northern Namibia and Angola. Travel to Angola was associated with excessive risk of malaria in males (OR 43.58 95% CI 2.12-896), but there was no corresponding risk associated with travel by females. This is the first study to reveal that gender can modify the effect of travel on risk of malaria. Amongst non-travellers, male gender was also associated with a higher risk of malaria compared with females (OR 1.95 95% CI 1.25-3.04). Other strong risk factors were sleeping away from the household the previous night, lower socioeconomic status, living in an area with moderate vegetation around their house, experiencing moderate rainfall in the month prior to diagnosis and living <15 km from the Angolan border. CONCLUSIONS: These findings highlight the critical need to target malaria interventions to young male travellers, who have a disproportionate risk of malaria in northern Namibia, to coordinate cross-border regional malaria prevention initiatives and to scale up coverage of prevention measures such as indoor residual spraying and long-lasting insecticide nets in high risk areas if malaria elimination is to be realized

Increasing the satisfaction of general practitioners with continuing medical education programs: A method for quality improvement through increasing teacher-learner interaction

BACKGROUND: Continuing medical education (CME) for general practitioners relies on specialist-based teaching methods in many settings. Formal lectures by specialists may not meet the learning needs of practitioners and may cause dissatisfaction with traditional CME. Increasing learner involvement in teaching programs may improve learner satisfaction. METHODS: A quality improvement program for CME for 18 general practitioners in the Tel Aviv region was designed as a result of dissatisfaction with traditional CME activities. A two-step strategy for change was developed. The CME participants first selected the study topics relevant to them from a needs assessment and prepared background material on the topics. In the second step, specialist teachers were invited to answer questions arising from the preparation of selected topics. Satisfaction with the traditional lecture program and the new participatory program were assessed by a questionnaire. The quality criteria included the relevance, importance and applicability of the CME topic chosen to the participant's practice, the clarity of the presentation and the effective use of teaching aids by the lecturer and the potential of the lecturer to serve as a consultant to the participant. RESULTS: The participatory model of CME significantly increased satisfaction with relevance, applicability and interest in CME topics compared to the traditional lecture format. CONCLUSIONS: Increased learner participation in the selection and preparation of CME topics, and increased interaction between CME teachers and learners results in increased satisfaction with teaching programs. Future study of the effect of this model on physician performance is required

Comparison of performance-based measures among native Japanese, Japanese-Americans in Hawaii and Caucasian women in the United States, ages 65 years and over: a cross-sectional study

BACKGROUND: Japanese (both in Japan and Hawaii) have a lower incidence of falls and of hip fracture than North American and European Caucasians, but the reasons for these differences are not clear. SUBJECTS AND METHODS: A cross-sectional study. We compared neuromuscular risk factors for falls using performance-based measures (chair stand time, usual and rapid walking speed, and grip strength) among 163 Japanese women in Japan, 681 Japanese-American women in Hawaii and 9403 Caucasian women in the United States aged 65 years and over. RESULTS: After adjusting for age, the Caucasian women required about 40% more time to complete 5 chair stands than either group of Japanese. Walking speed was about 10% slower among Caucasians than native Japanese, whereas Japanese-American women in Hawaii walked about 11% faster than native Japanese. Grip strength was greatest in Japan, which may reflect the rural farming district that this sample was drawn from. Additional adjustment for height, weight or body mass index increased the adjusted means of chair stand time and grip strength among Japanese, but the differences remained significant. CONCLUSIONS: Both native Japanese and Japanese-American women in Hawaii performed better than Caucasians on chair stand time and walking speed tests, and native Japanese had greater grip strength than Japanese in Hawaii and Caucasians. The biological implications of these differences in performance are uncertain, but may be useful in planning future comparisons between populations

Evaluation of the health-related quality of life of children in Schistosoma haematobium-endemic communities in Kenya: a cross-sectional study.

BACKGROUND: Schistosomiasis remains a global public health challenge, with 93% of the ~237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric. METHODOLOGY/PRINCIPAL FINDINGS: In our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2-18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5-18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (-4.0%, p<0.001) and among the lower socioeconomic quartiles (-2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid. CONCLUSIONS/SIGNIFICANCE: We conclude that exposure to urogenital schistosomiasis is associated with a 2-4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection

A Cross-Sectional Study of the Impact of Pain in Older People with Frailty: Findings from the Community Ageing Research 75+ (CARE75+) Study

Background: Pain prevalence is higher in older people with frailty compared to fit older people. However, little is known about pain impact on the lives of older people with frailty. Objectives: To investigate pain impact in community dwelling older people (≥75 years) using data from the Community Ageing Research 75+ (CARE75+) cohort study (UKCRN 18043). Methods: Participants were assessed as not frail, pre-frail or frail (phenotype model of frailty). Pain impact was measured using the Geriatric Pain Measure Short-Form (GPM-12), an instrument incorporating 10 items on how pain impacts on ambulation, social engagement, ability to accomplish tasks and sleep, along with current pain intensity and average pain intensity (last 7 days). Intrusive pain was calculated from an item in the Short-Form 36 questionnaire. Differences in the GPM-12 scores between frailty categories were compared using Kruskal-Wallis H tests. Logistic regression models were used to investigate the association between frailty and intrusive pain. Results: 887 participants: not frail 139; pre-frail 471; and frail 268. Total GPM-12 median (IQR): not-frail 5.0 (0.0, 12.5); pre-frail 10.0 (0.0, 27.5); and frail 40.0 (10.0, 65.0) (p ≤ 0.0001). Current pain: not frail 0.0 (0.0, 1.0); pre-frail 0 (0.0, 3.0); and frail 3.0 (0.0, 5.0) (p ≤ 0.0001). Average pain: not-frail 0.0 (0.0, 2.0); pre-frail 1 (0.0, 4.0); frail 4.0 (2.0, 6.8) (p ≤ 0.0001). There was a strong association between being frail and intrusive pain (adjusted for sex, ethniciaty, mood and high comorbid burden): OR 3.53 (95% CI 2.47, 5.04). Conclusions: This research has identified an important new finding that pain in older people with frailty appears to be of sufficient severity to impact negatively on multiple aspects of day-to-day life

Visualizing the emergence of the pseudogap state and the evolution to superconductivity in a lightly hole-doped Mott insulator

Superconductivity emerges from the cuprate antiferromagnetic Mott state with hole doping. The resulting electronic structure is not understood, although changes in the state of oxygen atoms appear paramount. Hole doping first destroys the Mott state yielding a weak insulator where electrons localize only at low temperatures without a full energy gap. At higher doping, the 'pseudogap', a weakly conducting state with an anisotropic energy gap and intra-unit-cell breaking of 90\degree-rotational (C4v) symmetry appears. However, a direct visualization of the emergence of these phenomena with increasing hole density has never been achieved. Here we report atomic-scale imaging of electronic structure evolution from the weak-insulator through the emergence of the pseudogap to the superconducting state in Ca2-xNaxCuO2Cl2. The spectral signature of the pseudogap emerges at lowest doping from a weakly insulating but C4v-symmetric matrix exhibiting a distinct spectral shape. At slightly higher hole-density, nanoscale regions exhibiting pseudogap spectra and 180\degree-rotational (C2v) symmetry form unidirectional clusters within the C4v-symmetric matrix. Thus, hole-doping proceeds by the appearance of nanoscale clusters of localized holes within which the broken-symmetry pseudogap state is stabilized. A fundamentally two-component electronic structure11 then exists in Ca2-xNaxCuO2Cl2 until the C2v-symmetric clusters touch at higher doping, and the long-range superconductivity appears.Comment: See the Nature Physics website for the published version available at http://dx.doi.org/10.1038/Nphys232

Observation of Interfacial Damage in a Silk-Epoxy Composite, Using a Simple Mechanoresponsive Fluorescent Probe

Polymer composites are found throughout the world both natural and artificial in origin. In the vast majority of applications, composites serve as structural support or reinforcement roles. Demand for lightweight tough composites is growing in multiple application spaces such as areospace, biomaterials, and infrastructure with physical properties as diverse as the applications. The unifying component in all composites is the presence of an interphase. Many measurement techniques and measurement tools have been developed for the study of this crucial region in composite materials. Many of these methods are great for the measurment and study of bulk properties or model systems. However, development of methods that permit the direct observation of interactions at the interphase during applied stress are needed. Here we employ fluorescence lifetime imaging and hyperspectral imaging to observe activation of a fluorogenic dye at the composite interface as a result of applied stress. The advantages of this sytem include commercial availability of the dye precursor, and simple one-pot functionalization. The attachment of the dye at the interface is easily monitored through emission wavelength shifts and fluorescence lifetime variations. Interfacial mechano-responsive dyes have potential for both fundamental studies as well as industrial use as a structural health monitoring tool.Funded by AFOS