A web-based life-style, exercise and activity intervention for people with progressive multiple sclerosis: Results of a single-arm feasibility study.

BACKGROUND: People with progressive Multiple Sclerosis often struggle to access appropriate and inclusive support for regular physical activity. The Lifestyle, Exercise and Activity Package (LEAP-MS) intervention, is a co-designed web-based physical activity intervention for people with progressive Multiple Sclerosis (MS). It consists of two key components; (1) web-based physical activity coaching with physiotherapists using self-management support strategies and 2) an interactive web-based platform including a physical activity information suite, an activity selection and planning tool and a participant-physiotherapist messaging system. We aimed to evaluate recruitment, retention and uptake, in a single arm feasibility study. METHODS: Participants with primary or secondary progressive MS with an Expanded Disability Status Scale score of 6 to 8 were recruited. Assessments included the MS Impact Scale (MSIS-29) and measures of participation at baseline, three and six months. All participants received the intervention which consisted of up to six web-based physiotherapy- led physical activity coaching sessions alongside access to web-based education and activity suites. Recruitment, retention and uptake data were summarised. Pre-defined progression criteria were used to guide feasibility assessment. Clinical outcome data were analysed descriptively. RESULTS: Fifty-eight percent (21/36) of those submitting expressions of interest were recruited; 76% completed follow-up. Pre-specified progression criteria for retention were met but recruitment did not meet progression criteria. The intervention achieved set fidelity criteria. At three months, 12 participants (75%) reported improvements in routine activities after the intervention. MSIS-29 physical scores improved by an average of eight points (95% CI -12.6 to -3.3). Improvements were also seen in MSIS-29 psychological scores and fatigue. Some improvements were maintained at six months. CONCLUSIONS: The LEAP-MS intervention is feasible and associated with improvements in MSIS-29 scores. The intervention facilitated partnership working between physiotherapists and people with progressive MS. Users developed valuable skills in supported self-management by focussing on enhancing physical activity to support overall wellbeing. This work has laid the foundations for a large-scale evaluation of a co-designed intervention with potential for far reaching impact on the lives of people with progressive MS.

Lifestyle, Exercise and Activity Package for People living with Progressive Multiple Sclerosis (LEAP-MS): adaptions during the COVID-19 pandemic and remote delivery for improved efficiency.

The LEAP-MS (Lifestyle, Exercise and Activity Package for People living with Progressive Multiple Sclerosis) study has developed an individualised supported self-management approach for physical activity for people with progressive multiple sclerosis (MS) and severe disability. The intervention has been evaluated in a single-arm feasibility study with embedded process evaluation. The feasibility study was due to open to recruitment during the COVID-19 2020-2021 pandemic, 1 month into the first UK-wide lockdown. We worked rapidly to implement adaptions to the trial procedures and intervention delivery that we believe are applicable to randomised controlled trials. Recruitment became predominantly via self-referral. Electronic consent was employed, with consent discussions occurring over the telephone. Registration, consent, eligibility assessment and data collection as well as the intervention (online physical activity tool) were via a secure, encrypted multi-user web-based platform for participants, physiotherapists and researchers accessible via various hardware. Physiotherapy consultations, as well as the process evaluation, were conducted remotely using video conferencing software or the telephone. A remote training package for physiotherapists and site initiations was also developed and electronic site files employed. Our adaptions are extremely topical given the COVID-19 situation, and whilst not what we had originally planned, have enabled successful delivery of the feasibility study and are relevant to conducting randomised controlled trials and meeting the needs of people with MS who are far more isolated than ever before. TRIAL REGISTRATION: ClinicalTrials.gov NCT03951181 . Registered on 15 May 2019.

endo,endo-Tetra-cyclo-[6.2.1.1(3,6).0(2,7)]dodeca-9-en-anti-11-yl 4-bromo-benzoate.

The title compound 1-OPBB, C(19)H(19)BrO(2), contains a dechlorinated and hydrogenated isodrin backbone with an anti-4-bromo-benzoate substituent at one of the methano bridges. The dihedral angle between the CO(2) ester plane and the benzene ring plane is 8.5 (2)°. In the crystal, the ester groups stack over benzene rings: the mol-ecules pack as conformational enanti-omers, with nearest parallel benzene ring planes separated by a perpendicular distance of 3.339 (1) Å. The nearest benzene-ring centroids are 5.266 (1) Šapart. Possible structural correlation with enhanced solvolytic reactivity is investigated.

Bicyclo-[2.2.1]hept-2-en-7-yl 4-bromo-benzoate.

The structure of the title compound, C(14)H(13)BrO(2), which contains a norbornenyl group and a 4-bromo-benzoate ester at the single C-atom bridge, has been redetermined [see McDonald & Trotter (1965 ▶). Acta Cryst.19, 456-463] to modern standards to establish high-precision geometrical data to compare with norbornyl and other tetra-cyclic 4-bromo-benzoates. Possible structural evidence is sought to help explain solvolytic reactivities.

Bicyclo-[2.2.1]hept-7-yl p-bromo-benzoate.

The title compound, C(14)H(15)BrO(2), contains a sterically unencumbered norbornyl group. The dihedral angle between the plane of the carboxyl-ate group and the mean plane of the adjacent benzene ring is 5.3 (2)°. The dihedral angle between the plane of the carboxyl-ate group and the norbornyl methano C-O bond is 4.5 (1)°, the methano C atom deviating by 0.141 (2) Šfrom this plane. In the crystal, mol-ecules pack as pairs of enanti-omers, with a distance of 3.747 (1) Šbetween the centroids of nearest parallel benzene rings.

Optimisation of hydraulic performance to maximise faecal coliform removal in maturation ponds.

The present study was conducted with the aim of improving faecal coliform (FC) and faecal streptococcus (FS) removal efficiencies in tertiary maturation stages of a sewage treatment plant in Southern England, where climatic conditions are sub-optimal. The research used intensive field assessments (bacteriological, general quality and hydraulic) to identify the parameters that affect the bacteriological quality of the effluent from three parallel maturation ponds (North, Central and South) of similar geometry and dimensions. An engineering intervention was carried out to convert the South pond to three channels to increase the L/W ratio from 9:1 to 79:1. Hydraulic tracer studies in the South pond with Rhodamine WT showed that the dispersion number 'd' was reduced from 0.37 (dispersed flow) to 0.074 by this intervention under similar flow conditions (4.5l/s). Hydraulic retention time was thus increased by 5h, delay in jet flow short-circuiting was increased from 2.5 to 17.5h thus increasing the exposure times for all elements. As a result of the intervention FC removal increased substantially. Maximum channel-lagoon efficiency of 99.84% was obtained at 4.5l/s and 19 degrees C, when exposure to sunlight was 17 h in summer. It is concluded that the channel configuration produces a higher hydraulic efficiency than conventional maturation ponds. It is therefore recommended as a viable engineering solution which permits a low-cost upgrading of plant performance, requiring no additional land, and with minimal maintenance costs.

Monitoring of iodinated X-ray contrast media in surface water.

A monitoring programme was carried out in order to determine iodinated X-ray contrast media (ICM) in the River Danube and to investigate the raw water quality for drinking water production at Langenau waterworks. The study revealed that the maximum concentrations of ICM (over 500 ng l(-1) for diatrizoic acid and iopamidol) were found in 2h-composite samples taken from the downstream of the Ulm/Neu-Ulm metropolitan area. By means of a concentration profile over one month the highest ICM concentrations were observed on weekdays. The extended data evaluation with principal component analysis shows that the upstream and downstream samples had different pattern of variations in ICM concentration and also demonstrates a clear change in ICM composition by the discharge of municipal wastewater. In addition to load profiles of ICM, time-dependent plots of principal component 1 exhibited peaks, indicating a short-term discharge of ICM between the two sampling sites. In conclusion, a point source for ICM contamination between the sampling sites in Ulm upstream and Leipheim downstream seems to be the reasonable explanation for peak ICM concentrations. Due to the observed high variations of ICM concentrations in river, the evaluation of natural waters by means of a single analysis is not representative.

Progress in the development and use of ferrate(VI) salt as an oxidant and coagulant for water and wastewater treatment.

This paper reviews the progress in preparing and using ferrate(VI) salt as an oxidant and coagulant for water and wastewater treatment. The literature revealed that due to its unique properties (viz. strong oxidizing potential and simultaneous generation of ferric coagulating species), ferrate(VI) salt can disinfect microorganisms, partially degrade and/or oxidise the organic and inorganic impurities, and remove suspended/colloidal particulate materials in a single dosing and mixing unit process. However, these findings have not yet lead to the full-scale application of ferrate(VI) in the water industry owing to difficulties associated with the relatively low yield of ferrate(VI), the instability of the chemical depending on its method of preparation, and the lack of adequate studies that have demonstrated its capabilities and advantages over existing water and wastewater treatment methods. Fundamental study is thus required to explore the new preparation methods focusing on increasing the production yield and product's stability and avoiding using hypochlorite or chlorine as the oxidant. Also, the application of ferrate(VI) in drinking water treatment has not been studied systematically and future work in this field is recommended.

Developing regional water surveillance in health region XIII, Peru; phase one report

Presenta una evaluación de la fase I del Programa Regional de Vigilancia de Agua en el Perú, con un curso de entrenamiento y análisis del agua del área de Huancayo, Jauja, Tarma. La mayoría de los sistemas estaban contaminados, sobretodo los de agua superficial. Los sistemas de tratamiento necesitan rehabilitación. Son esenciales 2 etapas en la estrategia de vigilancia del agua: investigar todos los sistemas de abastecimiento y vigilancia rutinaria

Informe sobre el programa de vigilancia del agua, fase 3a; resumen de actividades (1984-1986), implementación en la region piloto (1986), estrategia (1987-1990)

Señala los objetivos del programa, sus antecedentes y aspectos sobre población y administración de la ex-región de salud No. XIII, y sistemas urbanos y rurales existentes. Propone una estrategia para la implementación del programa. Estudia la expansión del programa de vigilancia a Lima Metropolitana y la rehabilitación de plantas de tratamiento y abastecimiento no tratados

Water surveillance regional training programmes and water treatment; water initiatives, proposal for a technical cooperation programme with the Ministry of Health, Peru

Trata en la primera parte, sobre los programas regionales de entrenamiento para monitoreo del agua, durante el período 1985-88, a través de DIGEMA/DISAR, en el Perú; esto incluye el equipamiento de sus laboratorios regionales y provinciales con equipo de pruebas para agua, el cual ha sido previamente diseñado y desarrollado como un equipo portátil, de acuerdo a las necesidades de este tipo de programas. Proporciona las características de este equipo. Se ocupa, en la segunda parte, de la necesidad de proporcionar cooperación técnica para estudios especiales en las áreas de prefiltración y la evaluación y mantenimiento de plantas de filtración de arena de acción lenta