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The impact of the COVID-19 pandemic on physical therapy practice for people with multiple sclerosis: A multicenter survey study of the RIMS network
No full textBackground
The impact of the COVID-19 pandemic on physical therapy services for people with multiple sclerosis (pwMS) is unknown. Therefore, the Special Interest Group for Mobility (SIG Mobility) of the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) has undertaken the initiative to examine the impact of the COVID-19 outbreak on physical therapy services and physical activity participation in pwMS across Europe, Israel and Australia.
Objective
To describe the impact of the COVID-19 outbreak on physical therapy practice from the perspective of the therapist.
Methods
An online survey was developed and conducted from December 2020 to July 2021. The survey (50 questions), included multiple-choice questions and open-ended responses.
Results
In total, 215 physical therapists (PT's) from 9 countries (Australia, Belgium, the Czech Republic, Ireland, Israel, Italy, Norway, Spain, and Turkey) participated in the study. The therapy most affected during the pandemic was aerobic training/conditioning exercises; 33.5% reported that these activities were either reduced or unavailable. In contrast, 15% of the PTs reported increased use of relaxation/mind body techniques and/or fatigue management programs during the pandemic. PTs reported a mixture of positive and negative feelings about the therapeutic sessions offered during the pandemic. Most reported positive feelings included “positive” (26.5%), and “optimistic” (24.7%). Negative feelings most frequently reported included “worried” (30.7%), and “hesitant” (20.9%). The PTs reported a 10% decrease in the use of hands-on techniques and a 10% increase in the use of oral instructions when treating moderately and severely pwMS during as compared to before the pandemic.
Conclusion
The COVID-19 pandemic has affected physical therapy services in pwMS internationally in terms of content, frequency of use and format
Management of anorexia nervosa in pregnancy: A systematic and state-of-the-art review
No full textAnorexia nervosa is a potentially severe, chronic, and relapsing mental disorder that is more common in women and girls during the reproductive years (usually defined as those aged 12–51 years). It is associated with suicide and mortality linked with the physical consequences of starvation. Although anorexia nervosa is a disorder of low prevalence, and even lower prevalence in pregnancy, it is associated with substantial risks for the mother and infant when under-recognised and undermanaged. Despite the complexity and risk of managing anorexia nervosa in pregnancy, few studies are available to guide care. We conducted a systematic review, identifying only eight studies that addressed the management of anorexia nervosa in pregnancy. These studies were case studies or case reports examining narrow aspects of management. Subsequently, we conducted a state-of-the-art review across research in relevant disciplines and areas of expertise for managing anorexia nervosa in pregnancy and synthesised the findings into recommendations and principles for multidisciplinary management of anorexia nervosa in pregnancy. These recommendations included a focus on the specialist mental health, obstetric, medical, and nutritional care required to ensure optimal outcomes for women and their infants. Despite the complexity and risks, a gap exists in the comprehensive guidelines and recommendations for managing anorexia nervosa in pregnancy. This Review provides multidisciplinary recommendations for clinical care in this area. Managing anorexia nervosa in pregnancy is an area of clinical care that requires a multidisciplinary approach and includes those experienced in managing high-risk pregnancies
Talking like a plant
No full textFollowing the work of Barbara Cassin, this paper proposes to examine certain ways of speaking that Aristotle described as not so much human as plant-like [homoioi phutôi] and to consider whether these non-human ways of speaking might yet adduce forms of discourse that serve to model how central principles of justice can be thought. The paper does this by drawing upon Cassin’s extensive engagement with Sophistry in the classical world together with her concerted interest in the activities of the Truth and Reconciliation Commission in post-apartheid South Africa. When Aristotle, in book Gamma of the Metaphysics, dismissed the speech of those spoke “otherwise” (for example, those who failed to obey the law of non-contradiction) he formalised a chauvinism that philosophy had, at least since Plato, derided as sophistry. For Cassin, however, this presumed superiority of one way of speaking over another is something that holds true only when the grounds and elemental terms of a discourse have been and remain uncontested. In this way, language in Aristotle is regulated in advance, and determines what is admissible in the court of discourse according to prescribed and recognisable forms. Accordingly, illuminated by Heidegger and yet (like Arendt) departing from his conclusions, Cassin explores the sense in which language is something ontologically constitutive but in a manner that contests rather than secures its speakers’ relations to one another. In place of a metaphysics and ethics of belonging and authenticity, Cassin’s work is oriented by figures of precarity and exile such that truth is not so much something to be discovered, once and for all, but to be contested, negotiated, and re-worked each and every time. Key to this form of discourse, the paper will claim, is the uniquely non-juridical approach to justice undertaken by the Truth and Reconciliation Commission. Here, as Cassin explains, rather than a logic of individual rights and wrongs, there is a performative role for those involved. This “politics via discourse” dislocates the identity of received (rational) subjects and allows for narrative testimony itself not only to bear witness to a past but to signal a future – one based not on the apportionment or allocation of justice but on its ongoing struggle (an eristics or agonistics) for a humanity to come
Single-cell multi-omic approaches define common molecular and cellular signals of dominant antigen-driven cells at the site of drug-induced Stevens Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) tissue damage
No full textHuman leukocyte antigen (HLA)-restricted CD8+ T-cells expressing dominant T-cell receptor (TCR) clonotypes are recently implicated drivers of keratinocyte cell death, cutaneous blistering, and mortality in drug-induced Stevens Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN). Signatures of these effector population(s) remain undefined in affected tissue but hold utility for early diagnosis and targeted therapy
Environmental impacts of agricultural plastic film mulch: Fate, consequences, and solutions
No full textLead ammunition residues in a hunted Australian grassland bird, the stubble quail (Coturnix pectoralis): Implications for human and wildlife health
Get PDFScavenging and predatory wildlife can ingest lead (Pb) from lead-based ammunition and become poisoned when feeding on shot game animals. Humans can similarly be exposed to ammunition-derived lead when consuming wild-shot game animals. Studies have assessed the degree of lead contamination in the carcasses of game animals but this scrutiny has not so far extended to Australia. Stubble quail (Coturnix pectoralis) are one of the only native non-waterfowl bird species that can be legally hunted in Australia, where it is commonly hunted with lead shot. The aim of this study was to characterize lead contamination in quail harvested with lead-based ammunition. The frequency, dimensions, and number of lead fragments embedded in carcasses were assessed through use of radiography (X-ray). From these data, the average quantity of lead available to scavenging wildlife was estimated along with potential risks to human consumers. We radiographed 37 stubble quail harvested by hunters using 12-gauge (2.75”) shotguns to fire shells containing 28 g (1 oz) of #9 (2 mm or 0.08” diameter) lead shot in western Victoria, Australia, in Autumn 2021. Radiographs revealed that 81% of carcasses contained embedded pellets and/or fragments with an average of 1.62 embedded pellets detected per bird. By excising and weighing a sample of 30 shotgun pellets (all had a mass of 0.75 grain or 48.6 mg), we calculated an average lead load of 78 mg/100 g of body mass. This was a conservative estimate, because fragments were not considered. This level of lead contamination was comparable to hunted bird species examined using similar methods in Europe. The quantity and characteristics of lead ammunition residues found suggest that predatory and scavenging wildlife and some groups of human consumers will be at risk of negative health impacts
Health promotion in an Australian Aboriginal community: the Growing Strong Brains® toolkit
Get PDFAim:
The aim of this paper is to describe the implementation and evaluation of the Growing Strong Brains® (GSB) toolkit in a remote Aboriginal community in Western Australia (WA) over a 2-year period, 2018–2019.
Background:
Ngala, a community service organisation in WA, developed the GSB toolkit in 2014, a culturally appropriate and interactive resource to build knowledge of early childhood development within Aboriginal communities. This was in response to evidence that a higher percentage of children in Aboriginal communities were developmentally vulnerable compared to the rest of the population. The GSB toolkit promotes awareness and understanding of early brain development pre-birth and in the early years of a child’s life.
Methods:
The project was underpinned by participatory action research (PAR). Reflective PAR review cycles (n = 5) monitored local community engagement, navigated challenges and utilised community strengths. Fifty-nine local service providers attended a 2-day formal training. Data were collected by using various methods throughout the project, including feedback following training, focus groups, surveys, one-on-one interviews using yarning techniques and reflective feedback from the Project Lead.
Findings:
Establishing local Aboriginal project staff was pivotal to the success of the project. When delivering services for and with Aboriginal people, it is essential that cultural competence, safety and decision-making is carried through from planning to implementation and evaluation, and involves genuine, respectful and authentic relationships. Sufficient time allocation directed towards building relationships with other service providers and local community members needs to be considered and built into future projects.
The Growing Strong Brains® project is embedded within the local community, and anticipated implementation outcomes were achieved. The support of the local people and service providers was beyond expectation, enabling the building of local capacity, and the development of a common understanding of the key messages from the GSB toolkit to allow integration throughout all levels of the community. This project has been important to build on the strategies necessary to introduce, implement and evaluate the GSB toolkit in other remote Aboriginal communities
Secure and Efficient General Circuits Attribute-Based Access Control in Cloud Computing
No full textThe access structure of a general circuit can represent the access control policy flexibility and has broad applications in the field of dense data access control. All previous proposals are declared to support fined-grain access control for encrypted data and secure sharing in cloud. However, these schemes have their limitations, as the circuit nodes can only output layer by layer, and the circuit depth of the access structure implemented in the system is a fixed value. In addition, recent results show that these schemes have serious security defects, such as unresisting collusion attacks and vulnerability of the ciphertext stored in cloud. This article aims at solving the problems mentioned above and a scheme with improved efficiency and security is proposed. In the presented scheme, the circuit access structure with any depth less than or equal to the maximum depth is realized through equivalent conversion of circuit. By modifying the parameter form of shares, we solved the limitation that the previous scheme could only output layer by layer upward, and realized that each node could output to any node with a depth greater than its own across layers. This scheme greatly reduces the redundant computational overhead and improves the encryption and decryption efficiency
A survey of image-based computational learning techniques for frost detection in plants
Get PDFFrost damage is one of the major concerns for crop growers as it can impact the growth of the plants and hence, yields. Early detection of frost can help farmers mitigating its impact. In the past, frost detection was a manual or visual process. Image-based techniques are increasingly being used to understand frost development in plants and automatic assessment of damage resulting from frost. This research presents a comprehensive survey of the state-of the-art methods applied to detect and analyse frost stress in plants. We identify three broad computational learning approaches i.e., statistical, traditional machine learning and deep learning, applied to images to detect and analyse frost in plants. We propose a novel taxonomy to classify the existing studies based on several attributes. This taxonomy has been developed to classify the major characteristics of a significant body of published research. In this survey, we profile 80 relevant papers based on the proposed taxonomy. We thoroughly analyse and discuss the techniques used in the various approaches, i.e., data acquisition, data preparation, feature extraction, computational learning, and evaluation. We summarise the current challenges and discuss the opportunities for future research and development in this area including in-field advanced artificial intelligence systems for real-time frost monitoring
Prophylactic melatonin for delirium in intensive care (Pro-MEDIC): A randomized controlled trial
No full textPurpose
Delirium is common in the critically ill, highly distressing to patients and families and associated with increased morbidity and mortality. Results of studies on preventative use of melatonin in various patient groups have produced mixed results. The aim of this study was to determine whether administration of melatonin decreases the prevalence of delirium in critically ill patients.
Methods
Multicentre, randomized, placebo-controlled, double-blind trial across 12 Australian ICUs recruiting patients from July 2016 to September 2019. Patients of at least 18 years requiring ICU admission with an expected length of stay (LOS) greater than 72 h; enrolled within 48 h of ICU admission. Indistinguishable liquid melatonin (4 mg; n = 419) or placebo (n = 422) was administered enterally at 21:00 h for 14 consecutive nights or until ICU discharge. The primary outcome was the proportion of delirium-free assessments, as a marker of delirium prevalence, within 14 days or before ICU discharge. Delirium was assessed twice daily using the Confusion Assessment Method for ICU (CAM-ICU) score. Secondary outcomes included sleep quality and quantity, hospital and ICU LOS, and hospital and 90-day mortality.
Results
A total of 847 patients were randomized into the study with 841 included in data analysis. Baseline characteristics of the participants were similar. There was no significant difference in the average proportion of delirium-free assessments per patient between the melatonin and placebo groups (79.2 vs 80% respectively, p = 0.547). There was no significant difference in any secondary outcomes including ICU LOS (median: 5 vs 5 days, p = 0.135), hospital LOS (median: 14 vs 12 days, p = 0816), mortality at any time point including at 90 days (15.5 vs 15.6% p = 0.948), nor in the quantity or quality of sleep. There were no serious adverse events reported in either group.
Conclusion
Enteral melatonin initiated within 48 h of ICU admission did not reduce the prevalence of delirium compared to placebo. These findings do not support the routine early use of melatonin in the critically ill