Physiotherapy students\u27 perceptions and experiences of clinical prediction rules

Objectives: Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. Design: Cross-sectional survey using a paper-based questionnaire. Participants: Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. Results: Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). Conclusions: The large majority of students in this sample knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them

Understanding bricolage in norm development: South Africa, the International Criminal Court, and the contested politics of transitional justice

Within international relations the normative agency of African actors is often downplayed or derided. This article develops the concept of bricolage to offer a novel understanding of norm development and contestation in international relations, including the role African actors play in this. We contend that a norm's core hypothesis can be thought of as the nucleus of a norm. In the case of complex international norms, if this core hypothesis is sufficiently vague and malleable, the norm will continue to attract a range of actors who may claim to share a commitment to enacting the core hypothesis even if they simultaneously promote a variety of potentially conflicting and contradictory meanings-in-use of the norm when doing so. Each meaning-in-use, we argue, might be thought of as a product of bricolage: a process of combining and adapting both new and second-hand materials, knowledges, values, and practices by an actor to address a problem in hand. Through a detailed study of the contestation of transitional justice between South Africa and the International Criminal Court, we elucidate how bricolage can help to illuminate the normative agency of African actors in shaping transitional justice. Processes of bricolage add complexity and potentially confusion to a norm's development, but bricolage also offers the potential for a creative and dynamic means by which a range of actors can inject pluralism, dexterity, and vitality into debates about a norm's meaning and operationalisation

Managing hoarding and squalor

Hoarding and squalor are complex conditions with a range of physical and mental comorbidities. GPs play a key role in identifying people who experience these conditions, screening for safety risks, referral to specialist services and encouraging people to accept treatment and ongoing monitoring. Treatment for contributing and comorbid conditions should be optimised, with the help of specialist services when required. Medicines should be reviewed and adherence confirmed. For moderate to severe hoarding and squalor, referral to specialist psychiatry, geriatrics and allied health services is recommended for thorough assessment, treatment of underlying conditions and ongoing management

More SPASS with Isabelle: superposition with hard sorts and configurable simplification

Sledgehammer for Isabelle/HOL integrates automatic theorem provers to discharge interactive proof obligations. This paper considers a tighter integration of the superposition prover SPASS to increase Sledgehammer’s success rate. The main enhancements are native support for hard sorts (simple types) in SPASS, simplification that honors the orientation of Isabelle simp rules, and a pair of clause-selection strategies targeted at large lemma libraries. The usefulness of this integration is confirmed by an evaluation on a vast benchmark suite and by a case study featuring a formalization of language-based security

Evaluation de la capacité de complexation des eaux naturelles de la rivière Saguenay, Canada

La rivière Saguenay est un affluent majeur du fleuve Saint-Laurent, Québec, Canada. La rivière Saguenay draine une région très industrialisée et se divise en deux sections : la section supérieure est peu profonde et constituée d'eau douce, tandis que la section en aval renferme un fjord profond caractérisé par une thermohalocline à environ 25 m. Nous avons caractérisé la capacité de complexation (CC) et la constante de stabilité critique (CSC) de ses eaux douces, dans la section supérieure de la rivière. Cinq différentes stations ont été échantillonnées le même jour; ces échantillons ont été fractionnés en fonction de la masse moléculaire nominale (NMM) des ligands dissous à l'aide de quatre colonnes de chromatographie par perméation de gel (GPC) Séphadex G-10, G-15, G-25 et G-50 utilisées en série. Pour les échantillons globaux, la CC diminue d'amont en aval passant de 0,32 à 0,14 µM. Nous n'avons pu identifier la cause de cette diminution qui pourrait être un simple effet de dilution ou une augmentation d'ions métalliques en solution. Une fois fractionnés, nous trouvons que la CC augmente avec NMM; par contre, la CC normalisée par unité de carbone est plus grande pour les ligands de plus faible NMM. Les CSC obtenues sont toutes similaires, environ 5 x 107 L mol-1, sauf pour les ligands ayant une NMM entre 700 et 1 800 g mol-1 avec une CSC de 27 x 107 L mol-1.The Saguenay River is a major affluent of the St. Lawrence River, Quebec, Canada. The Saguenay River which drains a heavily industrialized region can be subdivided into two sections: the upper section is rather shallow and contains freshwater as the lower one is a deep fjord characterized by a thermohalocline at about 25 m. This work aimed at identifying the possible modifications brought up by anthropogenic sources upon the complexation capacity of the freshwater of this River. Five different stations were sampled for surface water the same day on the upper section of the River. The samples were filtered on 0,4 µm membrane (pre-cleaned with HNO3). A portion was analyzed and other ones were fractionnated as a function of the nominal molecular mass (NMM) of dissolved ligands by using in series four gel permeation chromatographic (GPC) columns filled with Sephadex G-10, G-15, G-25 and G-50 respectively, the elution being dope by purified 18MOhms water. The complexation capacity (CC) and critical stability constant (CSC) of the different fractions have been characterized using a method based on free Cu2+ back-titration by Differential Pulsed Anodic Stripping Voltammetry (DPASV) and a 1:1 complexation scheme. Because copper was giving two unresolved peaks on the tailing of the oxygen peak, all polarograms have been deconvolved by a PASCAL computer program based on a least-sqares nonlinear fit using the Taylor differential correction technique. All results compiled were from the peak centered at - 60 mV against an Ag/AgCl reference. By manipulating the usual equations to determine CC and CSC with the free Cu2+ back-titration, we were able to calculate CC by three different routes and CSC by two different routes ; when enough reliable data were available for each route, all values obtained were concordant. So we observed that, going downstream, the CC decreased from 0,32 to 0,14 µM for whole samples. At this point, we cannot identity the cause of this decrease wether it is due to simple dilution or by addition of new dissolved metallic ions into the stream. Once fractionnated, CC measured was seen increasing with NMM but normalized CC per unit of carbon has been found to be greater for ligands with small NMM (normalized CC decreased with increasing NMM). The CSC obtained were all similar, about 5 x 107 L mol-1, excepted for ligands with NMM between 700 and 1 800 g mol-1, the CSC being 27 x 107 L mol-1 from the inverse linearized method

Cortical Training in the Management of Acute Upper Limb Burns: a pilot randomised controlled trial

The aim of this study is to examine the feasibility, safety and efficacy of a prophylactic cortical training programme in patients with an acute upper limb burn. A randomised controlled pilot study is being carried out at the Royal Perth Hospital (RPH) Telstra Burns Outpatient Department. Subjects who have sustained isolated upper limb burns and presented to RPH within seven days of injury are randomised into experimental or control groups. Subjects in the control condition receive usual physiotherapy care for four weeks; those in the experimental group receive usual care and the addition of a cortical training programme which includes hand laterality recognition training, mirror visual feedback exercises, and sensory discrimination training. The primary outcomes are upper limb function (QuickDASH) and pain intensity (Pain Detect Measure) at four weeks. Secondary outcomes include distress (Post Traumatic Checklist) fear avoidance (Modified Tampa Scale of Kinesophobia) self efficacy (Pain Self Efficacy Questionnaire) and hand laterality recognition performance (accuracy and speed). QuickDASH and Pain Detect Measure are also recorded weekly to monitor for adverse affects. Results to date will be presented. Initial analyses indicate the feasibility and safety of the technique in UL burn patients. However, a number of questions are raised with respect to the timing of treatment and the long term implications of such input

The translation, validity and reliability of the German version of the Fremantle Back Awareness Questionnaire

Background: The Fremantle Back Awareness Questionnaire (FreBAQ) claims to assess disrupted self-perception of the back. The aim of this study was to develop a German version of the Fre-BAQ (FreBAQ-G) and assess its test-retest reliability, its known-groups validity and its convergent validity with another purported measure of back perception. Methods: The FreBaQ-G was translated following international guidelines for the transcultural adaptation of questionnaires. Thirty-five patients with non-specific CLBP and 48 healthy participants were recruited. Assessor one administered the FreBAQ-G to each patient with CLBP on two separate days to quantify intra-observer reliability. Assessor two administered the FreBaQ-G to each patient on day 1. The scores were compared to those obtained by assessor one on day 1 to assess inter-observer reliability. Known-groups validity was quantified by comparing the FreBAQ-G score between patients and healthy controls. To assess convergent validity, patient\u27s FreBAQ-G scores were correlated to their two-point discrimination (TPD) scores. Results: Intra- and Inter-observer reliability were both moderate with ICC3.1 = 0.88 (95%CI: 0.77 to 0.94) and 0.89 (95%CI: 0.79 to 0.94), respectively. Intra- and inter-observer limits of agreement (LoA) were 6.2 (95%CI: 5.0±8.1) and 6.0 (4.8±7.8), respectively. The adjusted mean difference between patients and controls was 5.4 (95%CI: 3.0 to 7.8, p\u3c0.01). Patient\u27s FreBAQ-G scores were not associated with TPD thresholds (Pearson\u27s r = -0.05, p = 0.79). Conclusions: The FreBAQ-G demonstrated a degree of reliability and known-groups validity. Interpretation of patient level data should be performed with caution because the LoA were substantial. It did not demonstrate convergent validity against TPD. Floor effects of some items of the FreBAQ-G may have influenced the validity and reliability results. The clinimetric properties of the FreBAQ-G require further investigation as a simple measure of disrupted self-perception of the back before firm recommendations on its use can be made

Safety and feasibility of transcranial direct current stimulation (tDCS) combined with sensorimotor retraining in chronic low back pain: a protocol for a pilot randomised controlled trial

Introduction Chronic low back pain (LBP) is a common and costly health problem yet current treatments demonstrate at best, small effects. The concurrent application of treatments with synergistic clinical and mechanistic effects may improve outcomes in chronic LBP. This pilot trial aims to (1) determine the feasibility, safety and perceived patient response to a combined transcranial direct current stimulation (tDCS) and sensorimotor retraining intervention in chronic LBP and (2) provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present. Methods and analysis A pilot randomised, assessor and participant-blind, sham-controlled trial will be conducted. Eighty participants with chronic LBP will be randomly allocated to receive either (1) active tDCS + sensorimotor retraining or (2) sham tDCS + sensorimotor retraining. tDCS (active or sham) will be applied to the primary motor cortex for 20 min immediately prior to 60 min of supervised sensorimotor retraining twice per week for 10 weeks. Participants in both groups will complete home exercises three times per week. Feasibility, safety, pain, disability and pain system function will be assessed immediately before and after the 10-week intervention. Analysis of feasibility and safety will be performed using descriptive statistics. Statistical analyses will be conducted based on intention-to-treat and per protocol and will be used to determine trends for effectiveness. Ethics and dissemination Ethical approval has been gained from the institutional human research ethics committee (H10184). Written informed consent will be provided by all participants. Results from this pilot study will be submitted for publication in peer-reviewed journals. Trial registration number ACTRN1261600062448

Solubilities of pyrene in organic solvents: Comparison between chemical potential calculations using a cavity-based method and direct coexistence simulations

In this paper, we benchmark a cavity-based simulation method for calculating the relative solubility of large molecules in explicit solvents. The essence of the procedure is the accounting of the Gibbs energy change associated with an alchemical thermodynamic cycle where, in sequence, a cavity is created in a solvent, a solute is inserted in the cavity and the cavity is annihilated. The Gibbs energy change is equated to the excess chemical potential allowing the comparison of solubilities in different solvents. The results obtained using the cavity-based method are compared to direct large-scale molecular dynamics simulations performed using coarse-grained models for calculating the partition coefficient of pyrene between heptane and toluene. We demonstrate the applicability of this cavity-based technique under high pressure/temperature conditions.The authors gratefully acknowledge the generous funding and technical support for this work from BP Plc through the International Centre for Advanced Materials (ICAM) which made this research possible