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Non‐homogeneous distribution of inhibitory inputs among motor units in response to nociceptive stimulation at moderate contraction intensity
No full textPain significantly influences movement, yet the neural mechanisms underlying the range of observed motor adaptations remain unclear. This study combined experimental data and in silico models to investigate the contribution of inhibitory and neuromodulatory inputs to motor unit behaviour in response to nociceptive stimulation during contractions at 30% of maximal torque. Specifically, we aimed to unravel the distribution pattern of inhibitory inputs to the motor unit pool. Seventeen participants performed isometric knee extension tasks under three conditions: Control, Pain (induced by injecting hypertonic saline into the infra-patellar fat pad) and Washout. We identified large samples of motor units in the vastus lateralis (up to 53/participant) from high-density electromyographic signals, leading to three key observations. First, while motor unit discharge rates significantly decreased during Pain, a substantial proportion of motor units (14.8–24.8%) did not show this decrease and, in some cases, even exhibited an increase. Second, using complementary approaches, we found that pain did not significantly affect neuromodulation, making it unlikely to be a major contributor to the observed changes in motor unit behaviour. Third, we observed a significant reduction in the proportion of common inputs to motor units during Pain. To explore potential neurophysiological mechanisms underlying these results, we simulated the behaviour of motor unit pools with varying distribution patterns of inhibitory inputs. Our simulations support the hypothesis that a non-homogeneous distribution of inhibitory inputs, not strictly organised according to motor unit size, is a key mechanism underlying the motor response to nociceptive stimulation during moderate contraction intensity
Practical Guide: The active cycle of breathing technique (ACBT)
No full textThe active cycle of breathing technique (ACBT) is an airway clearance technique that consists of a five-step cycle with three essential components: breathing control, thoracic expansion exercises and forced expiration technique (a three-step sub-cycle of breathing control – huffing – breathing control).1 Breathing control aims to partially assist the patient to regain the control of breathing through relaxation and, during the process, gives the patient an opportunity to achieve the correct breathing pattern. This is followed by thoracic expansion exercises, which aim to entrain air into the basal airways behind the secretions. This is followed by a ‘huff’ or forced expiratory breath, which shifts the basal secretions to more proximal airways. The force of the huff induces dynamic compression of the airway in the direction of the lung bases, as far as the equal pressure point (EPP), a point where the pressure inside and outside the airway is equal. The EPP shifts further towards the more distal and smaller airways in proportion to the increase in intrapleural pressure and the duration of the huff. Put simply, secretion mobilisation is effected by a dynamic shift in the EPP
Assessing the implementation and effectiveness of China’s social credit system of the construction industry: a case study of Nanjing
Get PDFConstruction contractor evaluation is the first step in ensuring the successful completion of a project. Nowadays, the Chinese government has developed a social credit system (SCS) and proposed contractors’ credit scores as an additional factor to facilitate bidding decisions. Using Nanjing as a case study, this article investigates the status quo of construction contractors’ credit scoring. It evaluates how credit scores have impacted the public procurement of construction projects. This article utilizes data-driven approaches and conducts different statistical analyses based on the bidding results of 15,094 public projects and the credit scores of over 6,000 registered construction companies from 2014 to 2021. The results show that (1) around half the companies had no credit-changing activities; (2) credit scores are important when companies are bidding for medium, large, and extra-large projects; (3) large companies are more likely to have better credit ratings; and (4) credit scores have a significant impact on revenue generation. This article provides a basis for understanding the status quo and effectiveness of the SCS implementation in the Chinese construction industry and evaluating its impact on the public procurement of construction projects, which are often concerns of researchers, policymakers, and industry practitioners.</p
Doing justice when incorporating sustainability into pre-medical curricula
No full text1 WHAT PROBLEMS WERE ADDRESSED?There are increasing calls from students, universities and accrediting bodies to embed Planetary Health (including sustainability) in health professions education. With limited formal guidance, academics have been trialling different approaches. Crammed health professions programmes make it difficult to undertake curriculum changes. Major changes also require curriculum committee approval, which can take months, even years.2 WHAT WAS TRIED?As a stop-gap measure that minimally increased student workload, we included a Planetary Health ‘fact’ on the bottom of a single relevant PowerPoint slide in each 2-hour lecture across a 12-week pre-medical physiology subject, with references and links to further information relating to the health impacts of a changing climate. For example, the session introducing mucosal tissue highlighted the impact of pollution on the respiratory system. Other sessions discussed sports performance and outside temperature, disease outbreaks, or the environmental footprint of healthcare. To minimise any formal subject changes, the educator read the facts during lectures, but no time was devoted to discussion or assessment. The intention was to alert students to the environmental determinants of health and hopefully motivate them to follow up on the provided links. Towards the end of the 12-week semester, students were surveyed to check whether this stop-gap approach (the weekly fact) was sufficient to pique interest. Additionally, students were asked to define Planetary Health in an open-ended question, with experts evaluating the definitions for accuracy.3 WHAT LESSONS WERE LEARNED?Only 30% (9 out of the 30 responders) of pre-medical students reported following up on these facts. Despite this, there appeared to be some benefit in providing facts, as exemplified in this student comment: ‘My actions, behaviours or thoughts have not changed, but the facts have made me more conscious of the effects.’ From feedback analysis, the students' ability to provide a definition of Planetary Health, and their understanding of its core concepts, were, however, not enhanced by the sole provision of facts. To address this, the next iteration of the subject incorporated a formal introduction to Planetary Health, which included a five-minute pre-class video and a 10-minute discussion in the first lecture.Based on our experiences, we offer several recommendations for academics wanting to incorporate Planetary Health information within a subject. First, include a definition of Planetary Health at the outset, highlighting the interrelationship between the health of the planet and human health.1 Second, link the included content to the relevant Sustainable Development Goal (SDG). For example, by highlighting the impact of increasing global temperatures on human body performance (SDG13: Climate Action). Third, incorporate facts throughout the lectures, but refer to the Planetary Health definition and advance this concept each time a new fact is introduced. Fourth, encourage students to seek additional information on the environmental determinants of health and well-being as they apply to the subject content. In conclusion, time is required to introduce Planetary Health in a subject (and preferably throughout the course). With careful planning, it is possible to integrate facts longitudinally across the semester without adversely impacting already crammed curricula as a stop-gap approach while more wholesale curriculum planning is underway
Effect of blockchain and inter-organizational trust on collaboration between contractors and supply chain partners
Get PDFDespite conflicting opinions on blockchain’s impact on collaboration within construction projects, its definitive effect on the relationships between contractors and their supply chain partners (SCPs) remains largely unexplored. To address these gaps, this study constructed a conceptual framework that integrates blockchain with calculative trust, relational trust, and technology readiness. This framework was then evaluated using partial least squares structural equation modeling, drawing on a survey of 189 professionals working with contractors and their SCPs. Our findings underscore blockchain’s positive effect on collaboration between contractors and their SCPs. Two of the notable findings obtained from this study: (1) this relationship is mediated significantly by both calculative and relational trust, and (2) relational trust exhibited a more potent influence in mediating the effects of blockchain on collaboration than calculative trust did. Further, we found that technological readiness significantly bolstered the relationship between blockchain and collaboration
Authors response to ‘Tendential and unscientific opinion’ letter-to-the-editor by Dr. Marc Wuttke MD, PhD
No full textThe authors of this letter are aware of a recent ‘Letter to the Editor’ in response to our recently published editorial: Olson KA, Clewley D, Milne, N et al. (2024): Spinal manipulation and mobilization for pediatric conditions: time to stop the madness. J Man Manip Ther. 32(3):207-210. We are aware that this letter was published by the Journal of Manual & Manipulative Therapy and makes several of the same points as the Letter to Editor by Saedt [Citation1] that we responded to, point-by-point, with a response published in the same journal [Citation2]. We refer to our previous response letter that provides a rationale for why the inclusion of articles by Sacher et al. [Citation3–5], published after the completion of our scoping review, would have had no significant impact on our findings [Citation2]
Standing on the shoulders of giants: Predictors of perceived overqualification and its impact on adaptive behavior
Get PDFUtilizing affective event theory, the study investigates the roles of perceived organizational politics and boredom proneness as antecedents of perceived overqualification and its impact on adaptive behavior. Further, this research examines the mediating role of perceived overqualification between antecedents and adaptive behavior and the moderating role of meaningful work between POQ and adaptive behavior. This research obtained 289 responses from university lecturers and heads of departments of public and private sector universities in Pakistan using quantitative time lag study design and convenience sampling. Results indicate that perceived organizational politics and boredom proneness contribute to perceived overqualification. It has been found that the direct association of perceived overqualification with adaptive behavior is negative. This research found that perceived overqualification mediates the relationship between antecedents and adaptive behavior. Moreover, this research discovered that the relationship between perceived overqualification and adaptive behavior is positive when work is perceived as meaningful but negative when work lacks meaningfulness. The theoretical and practical implications, limitations, and recommendations for upcoming researchers are discussed.</p
Generative artificial intelligence use in evidence synthesis: A systematic review
No full textIntroduction:With the increasing accessibility of tools such as ChatGPT, Copilot, DeepSeek, Dall-E, and Gemini, generative artificial intelligence (GenAI) has been poised as a potential, research timesaving tool, especially for synthesising evidence. Our objective was to determine whether GenAI can assist with evidence synthesis by assessing its performance using its accuracy, error rates, and time savings compared to the traditional expert-driven approach.Methods:To systematically review the evidence, we searched five databases on 17 January 2025, synthesised outcomes reporting on the accuracy, error rates, or time taken, and appraised the risk-of-bias using a modified version of QUADAS-2.Results:We identified 3,071 unique records, 19 of which were included in our review. Most studies had a high or unclear risk-of-bias in Domain 1A: review selection, Domain 2A: GenAI conduct, and Domain 1B: applicability of results. When used for (1) searching GenAI missed 68% to 96% (median = 91%) of studies, (2) screening made incorrect inclusion decisions ranging from 0% to 29% (median = 10%); and incorrect exclusion decisions ranging from 1% to 83% (median = 28%), (3) incorrect data extractions ranging from 4% to 31% (median = 14%), (4) incorrect risk-of-bias assessments ranging from 10% to 56% (median = 27%).Conclusion:Our review shows that the current evidence does not support GenAI use in evidence synthesis without human involvement or oversight. However, for most tasks other than searching, GenAI may have a role in assisting humans with evidence synthesis
Are EDs the only option? Hospital-based alternatives to the emergency department for mental health crises: A scoping review
Get PDFMental health continues to have a significant negative impact on global health. Hospital emergency departments (EDs) serve as a first entry point for individuals in crisis, with the number of presentations to EDs for mental health continuing to increase. However, EDs remain problematic environments for patients receiving emergency psychiatric care, due to the lack of suitable space, resources and specialised staff training. The World Health Organization has acknowledged the need to restructure mental health services to prioritise accessibility and person-centred care. To address this need, a number of alternative crisis care services have been established, which provide short-term emergency psychiatric care. This scoping review aims to provide an overview of the types of crisis services available within or adjacent to a hospital service. A systematic search of CINAHL, Medline, SocIndex and PsycINFO was conducted, returning 1213 results. Following title and abstract, and full text screening, 17 sources were included in the final review. Alternative crisis care services situated within or near existing hospital sites were broadly grouped into four categories: psychiatric emergency services, crisis stabilisation or observation units, specialised services for specific populations and non-clinical crisis services. Of the included articles, 13 reported some form of service evaluation, examining a range of patient-, staff- and service-factors. Alternative crisis care services to the ED play a crucial role in providing accessible, localised support for individuals experiencing mental health crisis, potentially reducing the reliance on hospital-based services. However, to date, there is a lack of consistency in service descriptions, and comprehensiveness of service evaluations. Standardised and more thorough reporting of crisis care services is required to better understand what services are available, and the impact they are having on mental health crisis care
Diagnostic Assessment via Live Telehealth (Phone or Video) Versus Face-to-Face for the Diagnoses of Psychiatric Conditions: A Systematic Review
Get PDFObjective: To determine the validity of telephone or video interviews compared to face-to-face interviews for psychiatric diagnosis.Data Sources: We searched MEDLINE, Embase, and PsycINFO from inception to June 22, 2023, and performed backward and forward citation analysis on all included studies on August 3, 2023.Study Selection: We included primary studies comparing live telehealth (via telephone or videoconferencing) with face-to-face interviews using the same standardized diagnostic criteria for a mental health condition. Each patient had to undergo both modes of interviewing. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2.Results: This review included 35 studies. Seven clinical studies compared telehealth with face-to-face consultations for initial psychiatric diagnosis, finding that telehealth via video or telephone is a reliable alternative for some specific disorders or populations. The remaining 28 studies assessed the use of mental health standardized diagnostic instruments via telehealth for conditions such as depression, bipolar disorder, PTSD, social anxiety disorder, and autism spectrum disorder, demonstrating good agreement and reliability. Telehealth holds promise for psychiatric assessments, particularly when in-person evaluations are not feasible.Conclusions:Limited studies, mostly conducted before the expansion of telehealth during the COVID-19 pandemic, suggest that telehealth-based psychiatric diagnoses or assessments of various conditions are viable options. These should be considered in appropriate situations, settings, or environments. However, more research is needed as telehealth becomes more broadly utilized.<br/