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Intensive therapy after botulinum toxin in adults with spasticity after stroke versus botulinum toxin alone or therapy alone: a pilot, feasibility randomized trial
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
Botulinum toxin-A is provided for adults with post-stroke spasticity. Following injection, there is a variation in the rehabilitation therapy type and amount provided. The purpose of this study was to determine if it is feasible to add intensive therapy to botulinum toxin-A injections for adults with spasticity and whether it is likely to be beneficial.
Methods
Randomized trial with concealed allocation, assessor blinding, and intention to treat analysis. Thirty-seven adults (n = 3 incomplete or lost follow-up) with spasticity in the upper or lower limb were allocated to one of three groups: experimental group received a single dose of botulinum toxin-A plus an intensive therapy for 8 weeks, control group 1 received a single dose of botulinum toxin-A only, and control group 2 received intensive therapy only for 8 weeks. Feasibility was measured by examining recruitment, intervention (adherence, acceptability, safety), and measurement. Benefit was measured as goal achievement (Goal Attainment Scale), upper limb activity (Box and Block Test), walking (6-min walk test) and spasticity (Tardieu scale), at baseline (week 0), immediately after (week 8), and at three months (week 12).
Results
Overall recruitment fraction for the trial was 37% (eligibility fraction 39%, enrolment fraction 95%). The 26 participants allocated to receive intensive rehabilitation attended 97% of clinic-based sessions (mean 11 ± 2 h) and an averaged 58% (mean 52 ± 32 h) of prescribed 90 h of independent practice. There were no study-related adverse events reported. Although participants in all groups increased their goal attainment, there were no between-group differences for this or other outcomes at week 8 or 12.
Conclusion
Providing intensive therapy following botulinum toxin-A is feasible for adults with neurological spasticity. The study methods are appropriate for a future trial. A future trial would require 134 participants to detect a between-group difference of 7 points on Goal Attainment Scale t-scores with an alpha of 0.05 and power of 80%
Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens’ jury
Get PDFThis author accepted manuscript is made available following 12 month embargo from date of publication (March 2018) in accordance with the publisher’s archiving policyObjectives
Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens’ jury to elicit views of members of the public regarding consumer directed care in residential care.
Methods
A citizens’ jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public.
Results
The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person’s funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for.
Conclusions
The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users
Endoplasmic reticulum stress mediates 4,5-dichloro-2-n-octyl-4-isothiazolin-3-one (DCOIT)-induced toxicity and liver lipid metabolism changes in Nile tilapia (Oreochromis niloticus)
Get PDF© 2018 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (July 2018) in accordance with the publisher’s archiving policyDCOIT (4,5-dichloro-2-n-octyl-4-isothiazolin-3-one) is the main active ingredient in an emerging water environment antifoulant, the toxicity and environmental impacts of which need to be further investigated. Thus, this study examined the toxicity of DCOIT on Nile tilapia (Oreochromis niloticus), including its effects on behavior, respiration and energy metabolism as well as the role of endoplasmic reticulum stress (ER stress) in mediating its toxicity and metabolic changes. The changes in fish behavior, respiration, neuronal signal transmission, energy metabolism, ER stress, and liver histology were examined via acute (4 days) and chronic (28 days) exposures to 0, 3, 15, 30 μg/L DCOIT in vivo. Additionally, ER stress levels were measured in 24-h periods of hepatocyte exposure to 0, 3, 15, 30 and 300 μg/L DCOIT in vitro. The hyper-locomotor activities decreased, but the respiration rate increased after a 4-day acute exposure period, indicating that DCOIT exposure altered fish energy metabolism. After acute exposure at a low DCOIT concentration, the activation of ER stress induced triglyceride accumulation in the liver. After chronic exposure for 28 days, the prolonged ER stress induced a series of pathological cellular changes. At the cellular level, exposure to a high DCOIT concentration induced ER stress in the hepatocytes. In addition, as a neurotoxin, DCOIT has the potential to disrupt the neurotransmission of the cholinergic system, resulting in motor behavior disruption. This study demonstrates that DCOIT plays a role in time- and concentration-dependent toxicity and that changes in lipid metabolism are directly related to endoplasmic reticulum function after exposure to an antifouling agent. This work advances the understanding of the toxic mechanism of DCOIT, which is necessary for its evaluation.This work was supported by the National Basic Research Program (973 program) [grant number 2014CB138803] and R & D from Hainan University [grant number KYQD(ZR)1736]
Comparison of a sports-hydration drink containing high amylose starch with usual hydration practice in Australian rules footballers during intense summer training
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
Fluid deficits exceeding 1.6% can lead to physical and cognitive impairment in athletes. Sport drinks used by athletes are often hyper-osmolar but this is known to be suboptimal for rehydration in medical settings and does not utilize colonic absorptive capacity. Colonic absorption can be enhanced by fermentative production of short chain fatty acids (SCFA) from substrates such as high amylose maize starch (HAMS). This study therefore compared, in elite Australian Football League (AFL) players at the height of outdoor summer training, a novel dual-action sports oral rehydration strategy that contained HAMS as well as glucose, to their usual rehydration practices (Control). The primary outcome markers of hydration were hematocrit and body weight.
Methods
A randomized single-blind crossover study was undertaken in thirty-one AFL players; twenty-seven completed the study which was conducted on four days (two days in the Intervention arm and two in Control arm). The Intervention arm was comprised a 50-100 g evening preload of an acetylated HAMS (Ingredion Pty Ltd) followed by consumption of a specially formulated sports oral rehydration solution (SpORS) drink during intense training and recovery. Players followed their usual hydration routine in the Control arm. Quantitative assessments of body weight, hematocrit and urine specific gravity were made at three time-points on each day of training: pre-training, post-training (90 min), and at end of recovery (30–60 min later). GPS tracking monitored player exertion.
Results
Across the three time-points, hematocrit was significantly lower and body weight significantly higher in Intervention compared to Control arms (p < 0.02 and p = 0.001 respectively, mixed effects model). Weights were significantly heavier at all three assessment points for Intervention compared to Control arms (Δ = 0.30 ± 0.13, p = 0.02 pre-training; Δ = 0.43 ± 0.14, p = 0.002 post training; and Δ = 0.68 ± 0.14, p < 0.001 for recovery). Between the pre-training and end-of-recovery assessments, the Control arm lost 0.80 kg overall compared with 0.12 kg in the Intervention arm, an 85% lower reduction of bodyweight across the assessment period.
Conclusion
The combination of the significantly lower hematocrit and increased body weight in the Intervention arm represents better hydration not only at the end of training as well as following a recovery period but also at its commencement. The magnitude of the benefit seems sufficient to have an impact on performance and further studies to test this possibility are now indicated.The study was funded by Flinders Partners, which is the commercialisation arm of Flinders University of South Australia
Understanding the business versus care paradox in gambling venues: a qualitative study of the perspectives from gamblers, venue staff and counsellors
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
In recent years, greater emphasis has been placed on gambling venues to identify potential problem gamblers, respond appropriately and refer to treatment. In seeking the perspectives of problem gamblers, venue staff and treatment providers, this qualitative study investigates how problem gamblers experience being identified and referred for treatment by venue staff.
Methods
A semi-structured interview guide focusing on experiences and perceptions of problem gambling identification and referral for treatment in gaming venues was used to conduct 4 focus groups and 9 semi-structured in-depth interviews. Participants comprised 22 problem gamblers, 10 gambling venue staff and 8 problem gambling counsellors. Audio recordings were transcribed verbatim, and an interpretive phenomenological analysis was conducted.
Results
‘Role conflict’ was identified as a considerable source of stress for venue staff who described conflicting priorities in responding to problem gamblers whilst maintaining employer profit margins. Problem gamblers described offers of help from venue staff as hypocritical and disingenuous. Venue staff also described reluctance to make moral judgements through the identification of and engagement with problem gamblers, and gamblers described resentment in being singled out and targeted as a problem gambler. Being approached and offered referral to a counselling service was a rare occurrence among problem gamblers. This corresponded with reports by gambling counsellors.
Conclusions
Role conflict experienced by gambling venue staff and patrons alike inhibits effective referral of potential problem gamblers into treatment. Reducing the need for gambling venue staff to make a perceived moral judgement about the gambling behaviours of specific patrons may improve the reception of responsible gambling information and promote help-seeking.This work was supported by a Department for Communities and Social Inclusion grant DCSI459 to the Flinders Centre for Gambling Research
Developing romantic and sexual relationships: Exploring the lived experiences of people with complex communication needs
No full textThis abstract was prepared for the inaugural 'HDR Student Conference', Flinders University, November 2018. Copyright © the authorThis research investigates the lived experiences of people with complex communication needs (CCN) in developing romantic and sexual relationships. The United Nations Convention on the Rights of Persons With Disabilities (2013) asserts people with disabilities have the right to participate in social relationships equal to others and acknowledges the additional barriers they face in social relationships. This research asked: What are the lived experiences of people with complex communication needs in developing romantic or sexual relationships? What are the barriers and facilitators to developing romantic or sexual relationships for people with complex communication needs? Method: This research deliberately sought lived experiences and perspectives in an area that is seldom discussed openly. It used a Critical Hermeneutics phenomenological approach and Standpoint Theory to provide a deeper understanding of experiences. The inclusion criteria were, participants had to be 21 or older, have had a physical and communication disability since childhood, and use Augmentative and Alternative Communication (AAC). Results: Nine participants with CCN, aged from 21 to 70+, were interviewed. Twenty-one experiences were discussed. Three themes emerged from the analysis of these experiences: personal attributes, the traits people discussed as being influential in their relationships; intimate communication, the communication issues surrounding being intimate and engaging in sexual activity; and the power of others, the influences of the attitudes of others on relationships. Ableism was the predominant attitudinal barrier. Conclusion: The research suggests that people with CCN can successfully develop romantic and sexual relationships. However, ableist attitudes of others can have a significant impact on their relationships. The findings will offer new insights into the lives of adults with CCN
Use of U-isotopes in exploring groundwater flow and inter-aquifer leakage in the south-western margin of the Great Artesian Basin and Arckaringa Basin, central Australia
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(http://creativecommons.org/licenses/BY-NC-ND/4.0/) which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.The distribution of uranium isotopes (238U and 234U) in groundwaters of the south-western margin of the Great Artesian Basin (GAB), Australia, and underlying Arckaringa Basin were examined using groundwater samples and a sequential extraction of aquifer sediments. Rock weathering, the geochemical environment and α-recoil of daughter products control the 238U and 234U isotope distributions giving rise to large spatial variations. Generally, the shallowest aquifer (J aquifer) contains groundwater with higher 238U activity concentrations and 234U/238U activity ratios close to secular equilibrium. However, the source input of uranium is spatially variable as intermittent recharge from ephemeral rivers passes through rocks that have already undergone extensive weathering and contain low 238U activity concentrations. Other locations in the J aquifer that receive little or no recharge contain higher 238U activity concentrations because uranium from localised uranium-rich rocks have been leached into solution and the geochemical environment allows the uranium to be kept in solution. The geochemical conditions of the deeper aquifers generally result in lower 238U activity concentrations in the groundwater accompanied by higher 234U/238U activity ratios. The sequential extraction of aquifer sediments showed that α-recoil of 234U from the solid mineral phases into the groundwater, rather than dissolution of, or exchange with the groundwater accessible minerals in the aquifer, caused enrichment of groundwater 234U/238U activity ratios in the Boorthanna Formation. Decay of 238U in uranium-rich coatings on J aquifer sediments caused resistant phase 234U/238U activity ratio enrichment. The groundwater 234U/238U activity ratio is dependent on groundwater residence time or flow rate, depending on the flow path trajectory. Thus, uranium isotope variations confirmed earlier groundwater flow interpretations based on other tracers; however, spatial heterogeneity, and the lack of clear regional correlations, made it difficult to identify recharge and inter-aquifer leakage.This study and paper were funded by the Government of South Australia's Department of Environment, Water and Natural Resources (DEWNR), Australia under its Bioregional Assessment Program on the Arckaringa Basin, and AINSE Ltd (Award PGRA; ALNSTU11404)
Designing and implementing two facilitation interventions within the ‘Facilitating Implementation of Research Evidence (FIRE)’ study: a qualitative analysis from an external facilitators’ perspective
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International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: The "Facilitating Implementation of Research Evidence" study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators' ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation. Methods: Qualitative data sources included notes from monthly internal-external facilitator teleconference meetings, from closing events for the two facilitation interventions and summary data analyses from repeated interviews with 16 internal facilitators. Deductive and inductive data analysis was led by an independent researcher to evaluate how facilitation in practice compared to the logic pathways designed to guide fidelity in the delivery of the interventions. Results: The planned facilitation interventions did not work as predicted. Difficulties were encountered in each of the five elements of the logic pathway: recruitment and selection of appropriate internal facilitators, preparation for the role, ability to apply facilitation knowledge and skills at a local level, support and mentorship from external facilitators via monthly teleconferences, working collaboratively and enabling colleagues to implement guideline recommendations. Moreover, problems were cumulative and created tensions for the external facilitators in terms of balancing the logic pathway with a more real-world, flexible and iterative approach to facilitation. Conclusion: Evaluating an intervention that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. At a practical level, relational aspects of facilitation are critically important. It is essential to recruit and retain individuals with the appropriate set of skills and characteristics, explicit support from managerial leaders and accessible mentorship from more experienced facilitators. At a methodological level, there is a need for attention to the balance between fidelity and adaptation of interventions. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, informed by prospective use of process evaluation data and more detailed investigation of the context-facilitation dynamic.The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 223646
People of Diverse Genders and/or Sexualities and Their Animal Companions: Experiences of Family Violence in a Binational Sample.
Get PDF‘This is the peer reviewed version of the following article: Riggs, D. W., Taylor, N., Signal, T., Fraser, H., & Donovan, C. (2018). People of Diverse Genders and/or Sexualities and Their Animal Companions: Experiences of Family Violence in a Binational Sample. Journal of Family Issues, 39(18), 4226–4247;
which has been published in final form at
https://doi.org/10.1177/0192513X18811164
© The Author(s) 2018A significant body of research in the field of human-animal studies has focused on animals who live alongside humans within the home, with such animals often considered family members. To date, however, this research has focused almost exclusively on the experiences of heterosexual cisgender people, overlooking other diverse genders and/or sexualities. This paper seeks to address this gap by reporting on findings from a study of 503 people living in Australia or the United Kingdom. Specifically, the research sought to explore links between psychological distress, social support, family violence, and views about animal companions. Notable amongst the findings was an interaction between having experienced familial violence and living with an animal companion, and the impact of both on psychological distress and social support. The paper concludes by considering the implications of the findings for better understanding the lives of people of diverse genders and/or sexualities
The Anorexia Nervosa Genetics Initiative (ANGI): overview and methods
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available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (October 2018) in accordance with the publisher’s archiving policyBackground
Genetic factors contribute to anorexia nervosa (AN); and the first genome-wide significant locus has been identified. We describe methods and procedures for the Anorexia Nervosa Genetics Initiative (ANGI), an international collaboration designed to rapidly recruit 13,000 individuals with AN and ancestrally matched controls. We present sample characteristics and the utility of an online eating disorder diagnostic questionnaire suitable for large-scale genetic and population research.
Methods
ANGI recruited from the United States (US), Australia/New Zealand (ANZ), Sweden (SE), and Denmark (DK). Recruitment was via national registers (SE, DK); treatment centers (US, ANZ, SE, DK); and social and traditional media (US, ANZ, SE). All cases had a lifetime AN diagnosis based on DSM-IV or ICD-10 criteria (excluding amenorrhea). Recruited controls had no lifetime history of disordered eating behaviors. To assess the positive and negative predictive validity of the online eating disorder questionnaire (ED100K-v1), 109 women also completed the Structured Clinical Interview for DSM-IV (SCID), Module H.
Results
Blood samples and clinical information were collected from 13,363 individuals with lifetime AN and from controls. Online diagnostic phenotyping was effective and efficient; the validity of the questionnaire was acceptable.
Conclusions
Our multi-pronged recruitment approach was highly effective for rapid recruitment and can be used as a model for efforts by other groups. High online presence of individuals with AN rendered the Internet/social media a remarkably effective recruitment tool in some countries. ANGI has substantially augmented Psychiatric Genomics Consortium AN sample collection.Please refer to published article