Development of a simple biogas analyzer module (BAM) for real-time biogas production monitoring.

ABSTRACTAnaerobic digestion (AD) relies on the cooperation of specific microbial communities, making it susceptible to process disruptions that could impact biogas production. In this regard, this study presents a technological solution based on the Arduino platform, in the form of a simple online monitoring system that can track the produced biogas profile, named as biogas analyzer module (BAM). The applicability of the BAM focused on monitoring the biogas produced from sugarcane vinasse inoculated with sewage sludge biodigestion processed in mesophilic conditions (38 oC), in a pH range of 6.5-7.5, and following a three-stage operational model: (i) an adaptation (168 h), (ii) complete mixing (168 h), and (iii) bio-stimulation with glycerol (192 h). Then, the lab-made BAM was used to trace the produced biogas profile, which registered a total biogas volume of 8,719.86 cm3 and biomethane concentration of 95.79% (vol.), removing 90.8% (vol) of carbon dioxide (CO2) and 65.2% (vol) of hydrogen sulfide (H2S). In conclusion, the results ensured good accuracy and efficiency to the device created by comparisons with established standards (chromatographic and colorimetric methods), as well as the cost reduction. The developed device would likely be six times cheaper than what is available in the market.

Filling the gap between evidence, policy and practice: are 45 and Up Study researchers planning for impact?

AIM: To improve health outcomes, policy and practice decisions should be guided by relevant and timely evidence. High-quality, large-scale population data could play an essential role in supporting evidence-based decision making. The 45 and Up Study is a long-term, large-scale cohort study with more 250 000 participants aged 45 years and over from New South Wales (NSW), Australia. Data collected by the Study is accessible to researchers, government and non-governmental bodies. The study aimed to identify the proportion of researchers using data from the Study who intended to have an impact and achieved impact; the types of impact they intended and achieved; and the pathways through which they achieved it. METHODS: Using data extracted from the application, progress and final report documents for 25 projects using 45 and Up Study data from January 2011 until December 2017, we a) determined the proportion of projects that intended to have policy or practice impact and b) described the type of policy and practice impact achieved. RESULTS: We found that 88% (n = 22) of projects intended to have a policy or practice impact. Of those, 68% (n = 15) planned to influence or inform a policy or program, and 41% (n = 9) planned to share findings at conferences or in journals. Almost half of projects with intended impact (45%, n = 10) did not state how they planned to achieve impact. Approximately 16% of all projects (n = 4) reported achieving an impact on policy or services. The type of impact achieved by all four of these projects was influencing, informing or changing a policy or program. One of these four projects also achieved a change to legislation or regulation. CONCLUSIONS: Further strategies to promote a targeted approach to impact planning in research projects using datasets such as the 45 and Up Study would help guide researchers in achieving impact.

Global efficiency of the motor network is decreased in Parkinson's disease in comparison with essential tremor and healthy controls.

BACKGROUND: Graph theory (GT) is a mathematical field that analyses complex networks that can be applied to neuroimaging to quantify brain's functional systems in Parkinson's disease (PD) and essential tremor (ET). OBJECTIVES: To evaluate the functional connectivity (FC) measured by the global efficiency (GE) of the motor network in PD and compare it to ET and healthy controls (HC), and correlate it to clinical parameters. METHODS: 103 subjects (54PD, 18ET, 31HC) were submitted to structural and functional MRI. A network was designed with regions of interest (ROIs) involved in motor function, and GT was applied to determine its GE. Clinical parameters were analyzed as covariates to estimate the impact of disease severity and medication on GE. RESULTS: GE of the motor circuit was reduced in PD in comparison with HC (p .042). Areas that most contributed to it were left supplementary motor area (SMA) and bilateral postcentral gyrus. Tremor scores correlated positively with GE of the motor network in PD subgroups. For ET, there was an increase in the connectivity of the anterior cerebellar network to the other ROIs of the motor circuit in comparison with PD. CONCLUSIONS: FC measured by the GE of the motor network is diminished in PD in comparison with HC, especially due to decreased connectivity of left SMA and bilateral postcentral gyrus. This finding supports the theory that there is a global impairment of the motor network in PD, and it does not affect just the basal ganglia, but also areas associated with movement modulation. The ET group presented an increased connectivity of the anterior cerebellar network to the other ROIs of the motor circuit when compared to PD, which reinforces what it is known about its role in this pathology.

Participatory health through behavioural engagement and disruptive digital technology for postoperative rehabilitation: protocol of the PATHway trial.

INTRODUCTION: Postsurgical rehabilitation is critical for optimal recovery in people undergoing orthopaedic surgery. Currently, knee and lumbar spine postsurgical care is not standardised, economically sustainable, nor based on quality evidence, contributing to substantial clinical variation, poor outcomes and increasing healthcare costs. This protocol describes the design of a randomised controlled trial aiming to evaluate the effectiveness and cost-effectiveness of a postsurgical clinical pathway augmented by disruptive technology and compared with standardised rehabilitation alone, in decreasing pain and improving function after total knee replacement (TKR) or lumbar laminectomy (with or without fusion). METHODS: An assessor-blinded, parallel group, randomised controlled trial will be conducted to recruit 204 consenting participants (102 per arm) of whom 50% are undergoing TKR and 50% lumbar surgery. The intervention group will receive a 6-month technology-enabled rehabilitation package in addition to usual postsurgical care. The package includes (1) an exercise program delivered via the Physitrack app on the iPad, (2) a health-coaching program delivered via video calls and motivational messages, (3) use of physical activity tracker with goal setting and motivational reminders (Fitbit). For those undergoing TKR, the intervention will also include knee joint range of motion self-monitoring via the Goniometer app. The control group will receive usual postsurgical care. Participants will be followed up at 3, 6 and 12 months from the enrolment date. The primary outcome is pain measured with the Numerical Rating Scale at 3 months. Secondary outcomes include pain-related disability, quality of life, computer self-efficacy, physical activity participation and sedentary behaviour. Data analysis will be blinded and by intention-to-treat. A trial-based cost-effectiveness analysis will determine the potential incremental cost per quality-adjusted life-year gained. ETHICS AND DISSEMINATION: This protocol is approved by the human research ethics committee of the University of Sydney. Dissemination will occur through lay summary, infographics, conferences and journal publications. TRIAL REGISTRATION NUMBER: ACTRN12618001448235.

Vitamin D supplementation: position Statement of the Iberoamerican Society of Osteoporosis and Mineral Metabolism (SIBOMM).

BACKGROUND: Vitamin D (VD) deficiency is a global pandemic that affects more than a third of the population worldwide. The population of Latin America and the Caribbean exceeds 620 million inhabitants with diverse ethnic origins and different latitudes and altitudes, which make comparisons and generalizations difficult. AIM AND METHOD: We sought to establish an expert consensus regarding the recommendations for VD supplementation in Latin America by means of the Delphi methodology. RESULTS: The prophylactic dosage of VD in the general population should be individualized according to age, race, body weight, sun exposure of an individual, altitude, and dietary and exercise habits, without ruling out existing chronic diseases. CONCLUSION: The importance of VD has been widely documented and its deficiency is a pandemic. Many individuals have difficulty meeting daily VD requirements through food and the sun. The population of Latin America and the Caribbean has diverse ethnics, cultures, in addition to living in different latitudes and altitudes. Therefore, it is important to make a position on VD supplementation, given the different characteristics, ages and serum levels of 25(OH)D.

Effectiveness of Stepped-Care Intervention in Overweight and Obese Patients With Medial Tibiofemoral Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVE: To test the effectiveness of a 32-week, stepped-care intervention on disease remission rates in overweight and obese patients with medial tibiofemoral osteoarthritis (OA) compared to controls. METHODS: In this randomized controlled trial, eligible participants were ≥50 years of age with a body mass index of ≥28 kg/m2 and radiographic evidence of medial tibiofemoral OA. Participants were randomized to stepped-care (n = 87) or control group (n = 84). The stepped-care group received a 2-step intervention. The first step consisted of an 18-week diet and exercise program. The second step consisted of 4 treatment subgroups: 1) diet and exercise maintenance; 2) cognitive-behavioral therapy; 3) unloader knee brace; and 4) muscle strengthening exercises. Allocation into subgroups was based on disease remission state and clinical characteristics. The primary end point was the disease remission rate (yes/no) at 32 weeks, which was reached when participants achieved the Patient Acceptable Symptom State cutoff value for pain and for the patient global assessment of disease activity and/or functional impairment. RESULTS: Disease remission at 32 weeks was achieved by 18 of 68 (26%) in the control group and 32 of 82 (39%) in the stepped-care group (difference 12.6% [95% confidence interval -2.3, 27.4], P = 0.10). The stepped-care group showed an improvement in pain and function between baseline and 20 weeks. While functional improvement was maintained at 32 weeks, pain levels tended to get worse between weeks 20 and 32. CONCLUSION: The proposed intervention did not promote a significant difference in the rate of disease remission in comparison to the control group for overweight or obese patients with medial tibiofemoral OA.

Community-based online survey on seeking care and information for lower limb pain and injury in Australia: an observational study.

OBJECTIVES: Musculoskeletal pain is a leading cause of disability globally. In geographically and socioeconomically diverse countries, such as Australia, care seeking when someone experiences musculoskeletal pain is varied and potentially influenced by their individual characteristics, access to practitioners or perceived trustworthiness of information. This study explored how consumers currently access healthcare, how well it is trusted and if sociodemographic factors influenced healthcare utilisation. DESIGN: Anonymous online observational survey. SETTING: Australia. PARTICIPANTS: A convenience sample of 831 community-based individuals (18+ years). OUTCOME MEASURES: Descriptive analyses and generalised estimating equations were used to quantify healthcare-seeking behaviours, sources and trust of health information for (A) first-contact practitioners, (B) medical practitioners, and (C) other sources of information. RESULTS: Of the 761 respondents, 73% were females, 54% resided in capital cities. 68% of respondents had experienced pain or injury in more than one lower limb joint. Despite this, more than 30% of respondents only sought help when there had not been natural resolution of their pain. Physiotherapists had the highest odds of being seen, asked and trusted for healthcare information. The odds of seeking care from general practitioners were no higher than seeking information from an expert website. Older individuals and women exhibited higher odds of seeking, asking and trusting health information. CONCLUSION: Intelligible and trustworthy information must be available for consumers experiencing lower limb pain. Individuals, particularly younger people, are seeking information from multiple, unregulated sources. This suggests that healthcare professionals may need to invest time and resources into improving the trustworthiness and availability of healthcare information to improve healthcare quality.

National Osteoarthritis Strategy brief report: Prevention of osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is one of the most common and debilitating chronic joint conditions in Australia. A National Osteoarthritis Strategy (the Strategy) was developed to outline a national plan to achieve optimal health outcomes for people at risk of, or with, OA. OBJECTIVE: This article focuses on the theme of prevention of OA within the Strategy. DISCUSSION: The Strategy was developed by a leadership group, three working groups, an implementation planning committee, multisectoral stakeholders and public consultation. The Strategy's 'Prevention Working Group' identified two priorities for action: 1) implement programs that target the prevention of obesity and increase physical activity, 2) adhere to joint injury prevention programs. The lack of implementable policies that promote OA prevention exposes Australians and the public health system to an enormous burden. A set of evidence-based strategies was proposed to assist implementation throughout Australia.

Design, Delivery, Maintenance, and Outcomes of Peer-to-Peer Online Support Groups for People With Chronic Musculoskeletal Disorders: Systematic Review.

BACKGROUND: Online support groups (OSGs) are one way for people with chronic diseases, their family or friends, and health professionals to communicate, gain information, and provide social support. As the number of peer-to-peer OSGs for chronic musculoskeletal conditions grows, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective, and what strategies are being used to implement or increase consumer engagement. OBJECTIVE: The objectives of this systematic review of people with musculoskeletal conditions were to (1) describe the design features (functions, usage options, moderation, and expert input) of peer-to-peer OSGs, (2) describe the characteristics of the individuals using peer-to-peer OSGs, (3) synthesize the evidence on outcomes of participation, and (4) identify strategies used in the delivery and maintenance of OSGs. METHODS: A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer OSGs) was conducted in 6 databases. Results were filtered from 1990 (internet inception) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a 2-step process. Quantitative studies were appraised by 2 reviewers using the Risk Of Bias In Non-Randomized Studies of Interventions tool. Qualitative studies were appraised by 2 different reviewers using the Critical Appraisal Skills Programme checklist. Extracted data were synthesized narratively. RESULTS: We examined 21 studies with low to moderate risk of bias. Of these studies, 13 studies included OSGs hosted on public platforms, 11 studies examined OSGs that were conducted in English, and 6 studies used moderators or peer leaders to facilitate engagement. Studies either reported the number of OSG members (n=1985 across all studies) or the number of posts (range: 223-200,000). The majority of OSG members were females who were not full-time employees and with varied levels of education. There were no randomized controlled trials measuring the efficacy of OSGs. Qualitative and quantitative studies identified empowerment, social support, self-management behavior, and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. Sharing experiences and a greater level of engagement appeared to have an important influence on OSGs efficacy. The extent to which members posted on the website influenced engagement. CONCLUSIONS: Across a diverse range of designs, languages, included features, and delivery platforms, peer-to-peer OSGs for chronic musculoskeletal conditions attract predominantly female participants of all ages and education levels. The level of participation of a member appears to be related to their perceived benefit, health literacy, and empowerment. Future studies are needed to identify which design and maintenance strategies have superior efficacy and whether there are concomitant improvements in health outcomes for people with chronic musculoskeletal conditions resulting from participation in OSGs. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42018090326; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018090326.

Effects of energy-protein supplementation frequency on performance of primiparous grazing beef cows during pre and postpartum.

OBJECTIVE: Twenty-four pregnant Nellore primiparous grazing cows were used to evaluate the effects of energy-protein supplementation and supplementation frequency during pre (105 d before calving) and postpartum (105 d after calving) on performance and metabolic characteristics. METHODS: Experimental treatments consisted of a control (no supplementation), daily supplementation (1.5 kg/d of concentrate/animal) and infrequent supplementation (4.5 kg of concentrate/animal every three days). During the pre and postpartum periods, concentrations of blood metabolites and animal performance were evaluated. Ureagenesis and energy metabolism markers were evaluated at prepartum period. RESULTS: Supplementation frequency did not alter (p>0.10) body weight (BW), average daily gain (ADG), and carcass traits during pre and postpartum. The BW (p = 0.079), adjusted BW at day of parturition (p = 0.078), and ADG (p = 0.074) were greater for supplemented cows during the prepartum. The body condition score (BCS; p = 0.251), and carcass traits (p>0.10) were not affected by supplementation during prepartum. On postpartum, supplementation did not affect animal performance and carcass traits (p>0.10). The dry mater intake was not affected (p>0.10) by supplementation and supplementation frequency throughout the experimental period. Daily supplemented animals had greater (p<0.001) glucose levels than animals supplemented every three days. Supplementation and supplementation frequency did not alter (p>0.10) the levels of blood metabolites, neither the abundance of ureagenesis nor energy metabolism markers. CONCLUSION: In summary, our data show that the reduction of supplementation frequency does not cause negative impacts on performance and metabolic characteristics of primiparous grazing cows during the prepartum.

Nutritional strategies for heifers under grazing system: productive and nutritional performance, metabolic profile and ovarian activity.

The objective of this study was to evaluate the effects of nutritional strategies on productive and nutritional performance, metabolic profile, and ovarian activity in heifers under grazing in the tropics in Brazil. Forty Nellore heifers averaging 8.5 ± 0.06 months and 248.6 ± 3.3 kg body weight (BW) were distributed in a completely randomized 2 × 2 factorial design with four treatments and ten replicates. The evaluated strategies consisted of different amounts of energetic-protein supplement: (1) 4 g/kg of BW of supplement in the pre-weaning and post-weaning; (2) 4 g/kg of BW of supplement pre-weaning and 6 g/kg in the post-weaning; (3) 6 g/kg of BW of supplement in the pre-weaning and 4 g/kg of BW in the post-weaning and; (4) 6 g/kg of BW of supplement in the pre-weaning and post-weaning. Crude protein (CP) and organic matter (OM) intake were increased (P < 0.05) by increasing the amounts of supplement in the post-weaning. Additionally, increasing supplement amounts in the post-weaning increased the digestibility of OM and CP (P < 0.05). Means insulin and glucose concentrations were greater (P < 0.05) for heifers that received higher amounts of supplement in the post-weaning. Average daily gain and fat thickness in the rump were increased (P < 0.05) by increasing supplement amounts in the post-weaning. Amounts of supplement did not influence the body growth of heifers. However, follicular number, diameter, and progesterone concentration were greater (P < 0.05) for heifers that received higher amounts of supplement in the post-weaning. In summary, increasing supplement amounts in the post-weaning improve the performance, energy and metabolic status, and ovarian activity in beef heifers under grazing in the tropics. Due to higher intake of supplement, the heifers receiving 6 g/kg of BW post-weaning had greater responses, independently of the supplement amount received pre-weaning.

Exploring the Characteristics and Preferences for Online Support Groups: Mixed Method Study.

BACKGROUND: Osteoarthritis (OA) is a chronic, disabling, and prevalent disorder. As there is no cure for OA, long-term self-management is paramount. Support groups (SGs) can facilitate self-management among people living with OA. Understanding preferences in design and features of SGs, including online SGs (OSGs), among people with OA can inform future development of SG interventions for this condition. OBJECTIVE: The objective of this study was to investigate health care- and health information-seeking behavior, digital literacy, and preferences for the design of SGs in people with OA. The study also explored the perceived barriers and enablers to being involved in OSGs. METHODS: An online survey study was conducted with a mixed method design (quantitative and qualitative). Individuals aged ≥45 years with knee, hip, or back pain for ≥3 months were recruited from an extant patient database of the Institute of Bone and Joint Research via email invitations. Quantitative elements of the survey included questions about sociodemographic background; health care- and health information-seeking behavior; digital literacy; and previous participation in, and preferences for, SGs and OSGs. Respondents were classified into 2 groups (Yes-SG and No-SG) based on previous participation or interest in an SG. Group differences were assessed with Chi-square tests (significance level set at 5%). Responses to free-text questions relating to preferences regarding OSG engagement were analyzed qualitatively using an inductive thematic analysis. RESULTS: A total of 415 people with OA completed the survey (300/415, 72.3% females; 252/415, 61.0% lived in a major city). The Yes-SG group included 307 (307/415, 73.9%) participants. Between the Yes-SG and No-SG groups, there were no differences in sociodemographic characteristics, health care- and health information-seeking behavior, and digital literacy. An online format was preferred by 126/259 (48.7%) of the Yes-SG group. Trained peer facilitators were preferred, and trustworthiness of advice and information were highly prioritized by the respondents. Qualitative analysis for OSG participation revealed 5 main themes. Lack of time and motivation were the main barriers identified. The main enablers were related to accessibility, enjoyment of the experience, and the content of the discussed information. CONCLUSIONS: These findings highlight the preferences in design features and content of SGs and OSGs and may assist in the further development of such groups.

Pragmatic neural tissue management improves short-term pain and disability in patients with sciatica: a single-arm clinical trial.

Objectives: To evaluate the clinical effect of sciatic neural mobilization in combination with the treatment of surrounding structures for sciatica patients. Secondly, we were also interested in identifying possible baseline characteristics that may be associated with improvements in pain and disability for sciatica patients. Methods: Twenty-eight patients with a clinical diagnosis of sciatica were treated with neural mobilization, joint mobilization and soft tissue techniques. Pain intensity and lumbar disability were assessed at baseline and after treatment using a Numerical Rating Scale (0-10) and the Oswestry Disability Index (0-100), respectively. The pre- and post-intervention data were compared. The research protocol was registered under the number NCT03663842. Results: Participants attended an average of 16 (SD±5.6) treatmentsessions over an average of 12 weeks. Decrease in pain scores (before median = 8, after median = 2; p < 0.001) and improvement in lumbar disability scores (before median = 33.3%, after median = 15.6%; p < 0.001) were observed. A multiple linear regression analysis showed that duration of pain and age of the patient predicted the disability improvement: F (2, 24) = 4.084, p < 0.030, R2 = 0.254. Discussion: Patients with sciatica may benefit from neural mobilization in combination with manual therapy for pain and lumbar disability. Longer pain duration and younger age had a negative influence on lumbar disability improvement.

Funcionalidades carpintadas: imaginários cambiados entre escola e comunidade / Carpented functionalities: imaginaries interchange between school and community / Funcionalidades carpinadas: imaginarios cambiados entre escuela y comunidad

A reflexão contida neste trabalho é resultado de pesquisa realizada no período de 2011 a 2013, em escola pública do distrito de Igaraí, na cidade de Mococa, interior do Estado de São Paulo ­ Brasil, buscando possibilidades de percepção de imaginários e funcionalidades erigidas sobre e para a unidade escolar, junto a seus atores e distrito. Valendo-nos dos documentos produzidos pela unidade escolar, referência documental sobre o distrito e também de análise de entrevistas concedidas por atores envolvidos na constituição da vida escolar, encontramos localidades interpenetradas e em movimentos diversos, assincrônicos, cujas próprias funcionalidades declaradas e imaginadas mantinham-se precariamente sob constante negociações.(AU)

The reflection contained in this work is the result of research carried out from 2011 to 2013, in a public school in the district of Igaraí, in the city of Mococa, interior of the state of São Paulo - Brazil, seeking possibilities of perception of the imaginary and functionalities built on and to the school unit, along with its actors and district. Using the documents produced by the school unit, documentary reference about the district and also the analysis of interviews given by actors involved in the constitution of school life, we find interpenetrated and asynchronous localities, whose own declared and imagined functionalities remained precariously under constant negotiations.(AU)

La reflexión contenida en este trabajo es resultado de una investigación realizada en el período de 2011 a 2013, en escuela pública del distrito de Igaraí, en la ciudad de Mococa, interior del Estado de São Paulo - Brasil, buscando posibilidades de percepción de imaginarios y funcionalidades erigidas sobre y, para la unidad escolar, junto a sus actores y distrito. En los documentos producidos por la unidad escolar, referencia documental sobre el distrito y también de análisis de entrevistas concedidas por actores involucrados en la constitución de la vida escolar, encontramos localidades interpenetradas y en movimientos diversos, asincrónicos, cuyas propias características declaradas e imaginadas se mantenían precariamente bajo constantes negociaciones.(AU)

Delineation of a novel subgroup 16SrXIII-J phytoplasma, a 'Candidatus Phytoplasma hispanicum'-related strain, based on computer-simulated RFLP and phylogenetic analysis.

Symptoms of fruit phyllody and slow growth, which are suggestive of phytoplasma infection, were observed in strawberry plants cultivated in commercial fields. In order to provide evidence of association of phytoplasma with affected plants, assays for detecting and identifying were performed through computer-simulated restriction fragment length polymorphism (RFLP) and phylogenetic analysis. Total DNA was extracted from symptomatic and asymptomatic samples and used as template in nested PCR primed by the primers P1/Tint followed by R16F2n/16R2. Amplified DNA fragments of 1.2 kb from the 16S rRNA gene revealed the presence of phytoplasma in all symptomatic samples. Molecular detection was confirmed by electron transmission microscopy, which evidenced pleomorphic bodies in the phloem vessels. Nucleotide sequence representative of the strawberry phytoplasma shared 97.2 to 99 % similarity with phytoplasmas currently classified as members of the distinct subgroups within the 16SrXIII group. Similarity coefficient (F) values ranged from 0.70 to 0.92, indicating that strawberry phytoplasma delineates a new strain in addition to 'Candidatus Phytoplasma hispanicum'-related strains. The evolutionary tree displayed that this strain emerges as a new branch in relation to those previously described. The novel strain, designated SFP (strawberry fruit phyllody) phytoplasma represents the new 16SrXIII-J subgroup and its sequence, denominated SFP-Br02, was deposited in the GenBank database (EU719108). These findings contribute for the knowledge of the genetic diversity existing among members of the group 16SrXIII and establishes strawberry as an additional host of representatives of this group in Brazil.

Stepped care approach for medial tibiofemoral osteoarthritis (STrEAMline): protocol for a randomised controlled trial.

INTRODUCTION: Current guidelines recommend tailored interventions to optimise knee osteoarthritis (OA) management. However, models of care still have a 'one size fits all' approach, which is suboptimal as it ignores patient heterogeneity. This study aims to compare a stepped care strategy with standard care for overweight and obese persons with medial tibiofemoral OA. METHODS AND ANALYSIS: Participants will be randomised into two groups (85 each). The intervention will receive a diet and exercise programme for 18 weeks in the first step of the study. Disease remission will then be assessed using the Patient Acceptable Symptom State (PASS). PASS is defined as the highest level of symptom beyond which patients consider themselves well and takes into account pain intensity, patient's global assessment of disease activity and degree of functional impairment. In the second step, participants in remission will continue with diet and exercise. If remission is not achieved, participants will be assigned in a hierarchical order to cognitive behavioural therapy, knee brace or muscle strengthening for 12 weeks. The intervention will be decided based on their clinical presentation for symptoms of depression and varus malalignment. Participants without depression or varus malalignment will undertake a muscle strengthening programme. The control group will receive educational material related to OA management. Main inclusion criteria are age ≥50 years, radiographic medial tibiofemoral OA, body mass index (BMI) ≥28 kg/m2, knee pain ≥40 (Visual Analogue Scale, 0-100), PASS (0-100) >32 for pain and global assessment, and 31 for functional impairment. Outcomes will be measured at 20-week and 32-week visits. The primary outcome is disease remission at 32 weeks. Other outcomes include functional mobility; patient-reported outcomes; BMI; waist-hip ratio; quadriceps strength; symptoms of depression, anxiety and stress; and knee range of motion. The analysis will be performed according to the intention-to-treat principle. ETHICS AND DISSEMINATION: The local ethics committee approved this protocol (HREC/14/HAWKE/381). Dissemination will occur through presentations at international conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12615000227594.

Altered Functional Connectivity Between Precuneus and Motor Systems in Parkinson's Disease Patients.

Parkinson's disease (PD) is a neurodegenerative disorder that affects motor skills and cognition. As brain structure and function are compromised, functional magnetic resonance imaging (fMRI) can be a helpful tool to further investigate how intrinsic connectivity is impaired on the disease. The precuneus and medial prefrontal cortex (mPFC) are hub regions involved on the default mode network (DMN), a system that is active during rest and related to cognitive processes. We hypothesized that PD patients would present a decrease in functional connectivity among these two regions and the rest of the brain. Our goal was to identify regions in which functional connectivity to precuneus and mPFC was altered in PD. This study was based on resting-state fMRI data from 37 healthy subjects and 55 PD patients. Precuneus and mPFC were selected as seed regions in a whole brain functional connectivity mapping. As expected, we found abnormal connectivity from precuneus to motor system regions in PD patients, pointing toward a decreased connectivity in the disease. No significant group effects were found for the mPFC. Our findings suggest that internetwork connectivity from DMN to motor system is impaired in PD.

Comparison of physical examination performance of medical students trained by musculoskeletal versus non-musculoskeletal specialists.

AIM: To compare the musculoskeletal (MSK) physical examination skills, knowledge acquisition and performance of first-year medical students trained by MSK specialist tutors to students trained by non-MSK specialist tutors, after a 6-week MSK physical examination tutorial program. METHODS: Twenty-first year medical students took part in the study. They were recruited into two groups, according to their exposure to either an MSK specialist or a non-MSK specialist tutor during their 6-week MSK training block. Knowledge acquisition was measured via a pre- and post-training objective structured clinical examination (OSCE). We assessed students' self-belief and confidence levels regarding their newly acquired skills via a questionnaire. Independent t tests were used to examine mean group differences of OSCE scores and perceived level of confidence. RESULTS: Both groups demonstrated a significant improvement (3.9 and 3.8 points, respectively, on an eight-point scale for shoulder assessment, P < 0.01, 3.3 and 3.5, respectively, on a five-point scale for spine assessment, P < 0.01) in OSCE scores compared to baseline after completing the 6-week MSK physical examination tutorial program. There was no between-group difference in the OSCE scores from pre- to post-training (P = 0.92 for shoulder, P = 0.66 for spine) or for perceived level of confidence in performing a basic MSK examination after training (P = 0.91). CONCLUSION: Students exposed to MSK specialist tutors did not demonstrate increased skill levels or knowledge in the area of MSK physical examination compared to those receiving the same training under the supervision of non-MSK specialist tutors. Both student groups demonstrated improvement.

Performance, endocrine, metabolic, and reproductive responses of Nellore heifers submitted to different supplementation levels pre- and post-weaning.

The present study was conducted to evaluate the effects of high and low supplementation levels pre- and post-weaning on performance, endocrine, metabolic, and reproductive responses of Nellore heifers. Fifty Nellore heifers with 132 ± 9.9 kg average body weight (BW) and 138 ± 19 days of age were supplemented from 4 to 14 months. The heifers were distributed into five supplementation plans: HH-6 g/kg of BW of supplement pre- and post-weaning, HL-6 g/kg of BW of supplement pre-weaning and 3 g/kg post-weaning, LH-3 g/kg of BW pre-weaning and 6 g/kg of BW post-weaning, LL-3 g/kg of BW pre- and post-weaning, and CC-control, no supplementation. Interactions were not significant (P > 0.10). The level of supplement fed pre-weaning did not affect any of the performance variables evaluated at the end of the experiment (P > 0.10). There was a significant effect of supplementation and level of supplementation fed post-weaning on average daily gain (ADG) and final BW (P < 0.05). Overall ADG was also affected only by supplementation and level of supplement fed post-weaning (P < 0.05) with animals receiving 6 g/kg of BW post-weaning gaining more weight. Follicular diameter was greater in animals that received 6 g/kg of BW post-weaning (P < 0.05). In summary, performance, endocrine, metabolic, and reproductive variables evaluated in the current study were improved by the level of supplement fed post-weaning. Heifers receiving supplementation of 6 g/kg of BW post-weaning had greater responses, independent of the level received during the pre-weaning phase.