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Diagnostic accuracy of bedside screening tools for aspiration risk in acute stroke, a commentary
Get PDFDysphagia is common after stroke and can lead to serious complications including pneumonia and mortality. Bedside swallow screening tools for aspiration risk associated with dysphagia are available for use by healthcare professionals to quickly assess patients, put in place the necessary interventions and make referral to speech and language therapy. A Cochrane Systematic review aimed to identify the diagnostic accuracy of such tools for use in practice (Boaden et al. 2021). This commentary critically appraises and evaluates the systematic review and expands upon the findings in the context of clinical practice and further research
Specific adsorption of antiviral drugs on ionic liquid-modified metal–organic framework: Adsorption behavior, mechanism, and DFT analysis
No full textAs emerging contaminants, antiviral drugs (ATVs) in water pose an increasing threat to human health and the ecosystem. Using specific and selective adsorption methods to remove ATVs remains challenging due to their trace concentration in real matrices. In this study, pyridine ionic liquid ([BPy][Sal])-modified metal–organic framework (MOF), a type of novel material, was synthesized as [BPy][Sal]@MOF to adsorb ATVs with different molecular structures, i.e., Arbidol (Arb) and Favipiravir (Fav). Arb adsorption followed the pseudo-second-order model, indicating that chemisorption is the dominant process. The Langmuir isothermal model showed that the maximum adsorption capacities toward Arb and Fav were 506.9 and 35.3 mg g−1, respectively, suggesting specific adsorption of Arb on [BPy][Sal]@MOF. Density functional theory (DFT) was used to investigate the specific adsorption mechanism. The molecular electrostatic potential and the intermolecular weak interaction analysis using the DFT method illustrated that the amino hydrogens in MOF could form hydrogen bonds (Nsingle bondHPartial double bondO) with the hydroxyl oxygens in Arb. Simultaneously, the indole ring in Arb could cause π–π interaction with the pyridine ring in [BPy][Sal] part from [BPy][Sal]@MOF. In contrast, the adsorption of Fav only involved π–π interaction between the benzene rings in Fav and the MOF part from [BPy][Sal]@MOF. The adsorption energy and energy gap calculation results verified that the adsorption strength of Arb was higher than that of Fav, and the key role of [BPy][Sal] in [BPy][Sal]@MOF helped achieve specific adsorption was confirmed. [BPy][Sal]@MOF exhibited exceptional recyclability after five adsorption–desorption cycles in environmental waters, demonstrating its excellent adsorption performance in practical applications
Analysing Risks & Opportunities in UK-India FinTech Free Trade Agreement (FTA)
Get PDFThis paper examines the UK's role in Free Trade Agreements (FTAs) in the FinTech sector post-Brexit, focusing on global partnerships in international trade. Central to the UK's "Global Britain" strategy, the financial services sector is a key area of focus. The paper analyses the UK's ongoing FTA discussions with India, emphasizing the challenges and opportunities within the context of India's prominent tech sector and the outsourcing of UK financial services to India. Additionally, it reviews financial services components in successful FTAs between the UK and countries like Japan, Singapore, Australia, and New Zealand, as well as India’s agreements with the UAE and Japan, providing key insights for the UK-India FTA. This analysis, grounded in official documents and recent research, evaluates FinTech trade modes and regulatory barriers in both countries, offering case studies to illustrate these issues. It reviews responses and negotiations from regulatory bodies, other FTAs with countries like Australia, UAE, Singapore, and Japan.
The OECD DSTRI measures policy barriers to fintech trade, analysing key policy areas like infrastructure, electronic transactions, payment systems. India's DSTRI score of 0.28 suggests higher regulatory barriers compared to the UK's 0.02, highlighting significant challenges for digital service trade, particularly in infrastructure. The UK's "Global Britain" vision post-Brexit aims to enhance international influence but faces challenges related to "status insecurity" and foreign policy uncertainty. The UK-India Free Trade Agreement (FTA) negotiations underscore India's growing fintech sector's strategic importance. India's services sector, particularly IT and BPO, is a critical economic driver, contributing significantly to GDP. With 560 million internet users, India's expanding digital economy is an appealing partner for the UK. In 2023, UK-India trade reached £39.0 billion, with services comprising a significant share. The UK's £19.1 billion investment in India and India's £9.3 billion investment in the UK reflect strong economic ties, emphasizing a shift towards a service-oriented trade dynamic and the crucial role of financial services
Down Syndrome: Let's Work Together to End the Stereotypes
Get PDFEach year, we observe the 21st day of March as our World Down Syndrome Day. The goal is to raise public awareness of Down syndrome (DS) and encourage all member states, relevant organizations of the UN system, all member states, other international organizations, non-governmental organizations, and the private sector to join this effort. The epidemiology of DS is complex. The incidence of DS is estimated to be somewhere between 1 in 1,000 and 1 in 1,200 live births worldwide, but there may well be some temporal, racial/ethnic, and geographical variability in the prevalence of DS. Most infants with DS have an extra copy of chromosome 21, which occurs due to the failure of chromosome 21 to separate during gametogenesis. However, a minority with the same phenotype may have a Robertsonian translocation, an isochromosome, or a ring chromosome. Increasing information suggests that many of the most frequently seen phenotypic features may be rooted in sequential variability in only one band, the 21q22. The characteristic facial appearance, cardiac anomalies such as the endocardial cushion defect, neurodevelopmental delay, and many dermatoglyphic changes could result from a small region including the genes for superoxide dismutase in the region 21q22.1, the amyloid precursor protein mapping in 21q11.2-21.05, and six probes for single-copy sequences: D21S46 in 21q11.2-21.05, D21S47 and SF57 in 21q22.1-22.3, and D21S39, D21S42, and D21S43 in 21q22.3. Speaking from this medical perspective, we need to understand the pathophysiology of DS to meet their healthcare needs. If we could do so, we could make a small change in this world
Engaging Communities in Sulawesi Island, Indonesia: A Collaborative Approach to Modelling Marine Plastic Debris through Open Science and Online Visualization
Get PDFMarine litter poses a complex challenge in Indonesia, necessitating a well-informed and coordinated strategy for effective mitigation. This study investigates the seasonality of plastic concentrations around Sulawesi Island in central Indonesia during the monsoon-driven wet and dry seasons. By using open data and methodologies including the HYCOM and Parcels models, we simulated the dispersal of plastic waste over three months during both the southwest and northeast monsoons. Our research extended beyond data analysis, as we actively engaged with local communities, researchers, and policymakers through a range of outreach initiatives, including the development of a web application to visualize model results. Our findings underscore the substantial influence of monsoon-driven currents on surface plastic concentrations, highlighting the seasonal variation in the risk to different regional seas. This study adds to the evidence provided by coarser resolution regional ocean modelling studies, emphasizing that seasonality is a key driver of plastic pollution within the Indonesian archipelago. Inclusive international collaboration and a community-oriented approach were integral to our project, and we recommend that future initiatives similarly engage researchers, local communities, and decision-makers in marine litter modelling results. This study will work to support in the application of model results in solutions to the marine litter problem
Effects of a 10-week footstrike transition programme on tibial stress fracture probability; a randomized controlled intervention using finite element and probabilistic modelling
Get PDFIntroduction: The aim of this study was to undertake a randomized control trial examining the effects of a 10-week footstrike transition program on tibial stress fracture risk compared to control. Material and methods: Twenty habitual rearfoot strike runners were randomly assigned to either footstrike or control groups. The footstrike group undertook a graduated 10-week program which allowed them to convert their habitual rearfoot strike pattern, whereas the control group maintained normal training regime without any alterations to their strike pattern. Running biomechanics were collected using an eight-camera motion capture system and ground reaction forces using a force plate. Tibial strains were quantified using finite element modelling and stress fracture probability calculated via probabilistic modelling over 100 days of running. The primary outcome tibial stress fracture probability, and secondary outcomes running biomechanics, muscle forces, joint contact forces, and tibial strain indices; were measured at baseline and 10-weeks. Results: Intention-to-treat analyses revealed no significant alterations in the primary outcome (Footstrike: baseline = 12.82% & 10-weeks = 10.82%, Control: baseline = 15.43% & 10-weeks = 13.39%) between arms. However, alterations in the strike index (Footstrike: baseline = 21.79% & 10-weeks = 65.74%, Control: baseline = 13.61% & 10-weeks = 12.41%) and the loading rate (Footstrike: baseline = 165.85BW/s & 10-weeks = 100.01 BW/s, Control: baseline = 170.13 BW/s & 10-weeks = 197.87 BW/s) were significantly greater in the footstike group compared to control. Conclusion: This trial concludes that the footstrike intervention adopted in this study was not effective in mediating improvements tibial stress fracture risk, although future intervention trials could examine the efficacy of footstrike modification on other musculoskeletal injuries in runners
A modern way to teach and practice manual therapy
Get PDFBackground
Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care.
Purpose
The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies.
Methods
A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements.
Conclusions
Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model
Capivasertib in combination with enzalutamide for metastatic castration resistant prostate cancer after docetaxel and abiraterone: Results from the randomized phase II RE-AKT trial
Get PDFPTEN loss and aberrations in PI3K/AKT signaling kinases associate with poorer response to abiraterone acetate (AA) in metastatic castration-resistant prostate cancer (mCRPC). In this study, we assessed antitumor activity of the AKT inhibitor capivasertib combined with enzalutamide in mCRPC with prior progression on AA and docetaxel. This double-blind, placebo-controlled, randomized phase 2 trial, recruited men ≥ 18 years with progressing mCRPC and performance status 0-2 from 15 UK centers. Randomized participants (1:1) received enzalutamide (160 mg orally, once daily) with capivasertib (400 mg)/ placebo orally, twice daily on an intermittent (4 days on, 3 days off) schedule. Primary endpoint was composite response rate (RR): RECIST 1.1 objective response, ≥ 50 % PSA decrease from baseline, or circulating tumor cell count conversion (from ≥ 5 at baseline to < 5 cells/7.5 mL). Subgroup analyses by PTEN status were pre-planned. Overall, 100 participants were randomized (50:50); 95 were evaluable for primary endpoint (47:48); median follow-up was 43 months. RR were 9/47 (19.1 %) enzalutamide/capivasertib and 9/48 (18.8 %) enzalutamide/placebo (absolute difference 0.4 % 90 %CI -12.8 to 13.6, p = 0.58), with similar results in the PTEN loss subgroup. Irrespective of treatment, OS was significantly worse for PTEN loss (10.1 months [95 %CI: 4.6-13.9] vs 14.8 months [95 %CI: 10.8-18]; p = 0.02). Most common treatment-emergent grade ≥ 3 adverse events for the combination were diarrhea (13 % vs 2 %) and fatigue (10 % vs 6 %). Combined capivasertib/enzalutamide was well tolerated but didn't significantly improve outcomes from abiraterone pre-treated mCRPC. [Abstract copyright: Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.
The effectiveness of custom hard-shell 3D-printed foot orthoses in a cohort of patients who did not respond to treatment with custom ethylene-vinyl-acetate (EVA) foot orthoses
No full textBackground: Patients who do not achieve positive outcomes with custom ethylene-vinyl-acetate (EVA) foot orthoses will often be escalated to other services for treatment, which may include surgery.
Objective: This study aimed to explore the effectiveness of custom hard-shell 3D-printed foot orthoses for patients who did not respond to treatment with custom EVA foot orthoses and were being considered for treatment escalation.
Design: An eight-week clinical evaluation and a two-year review of relevant medical records.
Method: Thirty-six consecutive patients with a range of musculoskeletal lower limb pathology who remained symptomatic after 12-weeks use of custom EVA foot orthoses were fitted with custom hard-shell 3D-printed foot orthoses. The Foot Health Status Questionnaire was used to assess patients at baseline and eight-week follow-up in conjunction with the Client Satisfaction with Device module of the Orthotics and Prosthetics User Survey. Patients were categorised as responders or non-responders based on their change in pain scores. A review of relevant medical records two years after receiving their orthoses determined if patients required further treatment for their initial condition.
Results: Across the full cohort there were significant improvements in pain, function and foot health. At follow-up, responders reported significantly improved pain, function and foot health compared with non-responders. Twenty-six patients (12 responders, 14 non-responders) required no further treatment for their original condition after two years.
Conclusions: Custom hard-shell 3D-printed foot orthoses have the potential to improve pain, function, foot health, and provide satisfaction in patients with lower limb musculoskeletal conditions which do not improve with custom EVA foot orthoses