Critical role of water conditions in the responses of autumn phenology of marsh wetlands to climate change on the Tibetan Plateau.

The Tibetan Plateau, housing 20% of China's wetlands, plays a vital role in the regional carbon cycle. Examining the phenological dynamics of wetland vegetation in response to climate change is crucial for understanding its impact on the ecosystem. Despite this importance, the specific effects of climate change on wetland vegetation phenology in this region remain uncertain. In this study, we investigated the influence of climate change on the end of the growing season (EOS) of marsh wetland vegetation across the Tibetan Plateau, utilizing satellite-derived Normalized Difference Vegetation Index (NDVI) data and observational climate data. We observed that the regionally averaged EOS of marsh vegetation across the Tibetan Plateau was significantly (p < .05) delayed by 4.10 days/decade from 2001 to 2020. Warming preseason temperatures were found to be the primary driver behind the delay in the EOS of marsh vegetation, whereas preseason cumulative precipitation showed no significant impact. Interestingly, the responses of EOS to climate change varied spatially across the plateau, indicating a regulatory role for hydrological conditions in marsh phenology. In the humid and cold central regions, preseason daytime warming significantly delayed the EOS. However, areas with lower soil moisture exhibited a weaker or reversed delay effect, suggesting complex interplays between temperature, soil moisture, and EOS. Notably, in the arid southwestern regions of the plateau, increased preseason rainfall directly delayed the EOS, while higher daytime temperatures advanced it. Our results emphasize the critical role of hydrological conditions, specifically soil moisture, in shaping marsh EOS responses in different regions. Our findings underscore the need to incorporate hydrological factors into terrestrial ecosystem models, particularly in cold and dry regions, for accurate predictions of marsh vegetation phenological responses to climate change. This understanding is vital for informed conservation and management strategies in the face of current and future climate challenges.

Attenuation of Methane Oxidation by Nitrogen Availability in Arctic Tundra Soils.

CH4 emission in the Arctic has large uncertainty due to the lack of mechanistic understanding of the processes. CH4 oxidation in Arctic soil plays a critical role in the process, whereby removal of up to 90% of CH4 produced in soils by methanotrophs can occur before it reaches the atmosphere. Previous studies have reported on the importance of rising temperatures in CH4 oxidation, but because the Arctic is typically an N-limited system, fewer studies on the effects of inorganic nitrogen (N) have been reported. However, climate change and an increase of available N caused by anthropogenic activities have recently been reported, which may cause a drastic change in CH4 oxidation in Arctic soils. In this study, we demonstrate that excessive levels of available N in soil cause an increase in net CH4 emissions via the reduction of CH4 oxidation in surface soil in the Arctic tundra. In vitro experiments suggested that N in the form of NO3- is responsible for the decrease in CH4 oxidation via influencing soil bacterial and methanotrophic communities. The findings of our meta-analysis suggest that CH4 oxidation in the boreal biome is more susceptible to the addition of N than in other biomes. We provide evidence that CH4 emissions in Arctic tundra can be enhanced by an increase of available N, with profound implications for modeling CH4 dynamics in Arctic regions.

Global methane and nitrous oxide emissions from inland waters and estuaries.

Inland waters (rivers, reservoirs, lakes, ponds, streams) and estuaries are significant emitters of methane (CH4 ) and nitrous oxide (N2 O) to the atmosphere, while global estimates of these emissions have been hampered due to the lack of a worldwide comprehensive data set of CH4 and N2 O flux components. Here, we synthesize 2997 in-situ flux or concentration measurements of CH4 and N2 O from 277 peer-reviewed publications to estimate global CH4 and N2 O emissions from inland waters and estuaries. Inland waters including rivers, reservoirs, lakes, and streams together release 95.18 Tg CH4  year-1 (ebullition plus diffusion) and 1.48 Tg N2 O year-1 (diffusion) to the atmosphere, yielding an overall CO2 -equivalent emission total of 3.06 Pg CO2  year-1 . The estimate of CH4 and N2 O emissions represents roughly 60% of CO2 emissions (5.13 Pg CO2  year-1 ) from these four inland aquatic systems, among which lakes act as the largest emitter for both CH4 and N2 O. Ebullition showed as a dominant flux component of CH4 , contributing up to 62%-84% of total CH4 fluxes across all inland waters. Chamber-derived CH4 emission rates are significantly greater than those determined by diffusion model-based methods for commonly capturing of both diffusive and ebullitive fluxes. Water dissolved oxygen (DO) showed as a dominant factor among all variables to influence both CH4 (diffusive and ebullitive) and N2 O fluxes from inland waters. Our study reveals a major oversight in regional and global CH4 budgets from inland waters, caused by neglecting the dominant role of ebullition pathways in those emissions. The estimated indirect N2 O EF5 values suggest that a downward refinement is required in current IPCC default EF5 values for inland waters and estuaries. Our findings further indicate that a comprehensive understanding of the magnitude and patterns of CH4 and N2 O emissions from inland waters and estuaries is essential in defining the way of how these aquatic systems will shape our climate.

Non-native plant invasion can accelerate global climate change by increasing wetland methane and terrestrial nitrous oxide emissions.

Approximately 17% of the land worldwide is considered highly vulnerable to non-native plant invasion, which can dramatically alter nutrient cycles and influence greenhouse gas (GHG) emissions in terrestrial and wetland ecosystems. However, a systematic investigation of the impact of non-native plant invasion on GHG dynamics at a global scale has not yet been conducted, making it impossible to predict the exact biological feedback of non-native plant invasion to global climate change. Here, we compiled 273 paired observational cases from 94 peer-reviewed articles to evaluate the effects of plant invasion on GHG emissions and to identify the associated key drivers. Non-native plant invasion significantly increased methane (CH4 ) emissions from 129 kg CH4 ha-1  year-1 in natural wetlands to 217 kg CH4 ha-1  year-1 in invaded wetlands. Plant invasion showed a significant tendency to increase CH4 uptakes from 2.95 to 3.64 kg CH4 ha-1  year-1 in terrestrial ecosystems. Invasive plant species also significantly increased nitrous oxide (N2 O) emissions in grasslands from an average of 0.76 kg N2 O ha-1  year-1 in native sites to 1.35 kg N2 O ha-1  year-1 but did not affect N2 O emissions in forests or wetlands. Soil organic carbon, mean annual air temperature (MAT), and nitrogenous deposition (N_DEP) were the key factors responsible for the changes in wetland CH4 emissions due to plant invasion. The responses of terrestrial CH4 uptake rates to plant invasion were mainly driven by MAT, soil NH4 + , and soil moisture. Soil NO3 - , mean annual precipitation, and N_DEP affected terrestrial N2 O emissions in response to plant invasion. Our meta-analysis not only sheds light on the stimulatory effects of plant invasion on GHG emissions from wetland and terrestrial ecosystems but also improves our current understanding of the mechanisms underlying the responses of GHG emissions to plant invasion.

The environmental release and ecosystem risks of illicit drugs during Glastonbury Festival.

Reported high drug use at music festivals coupled with factors such as public urination can lead to the direct release of illicit drugs into the environment. Glastonbury Festival 2019 had 203,000 attendees, its site is intercepted by the Whitelake River providing a direct route for illicit drug pollution into the local environment. We tested for popular illicit drugs such as cocaine and MDMA in the river upstream and downstream of the festival site as well as in the neighbouring Redlake River. Both rivers were sampled the weeks before, during and after the festival. Cocaine, benzoylecgonine and MDMA were found at all sample sites; concentrations, and mass loads (mass carried by the river per unit of time) were significantly higher in the Whitelake site, downstream of the festival. MDMA mass loads were 104 times greater downstream in comparison to upstream sites (1.1-61.0 mg/h vs 114.7 mg/h; p < .01). Cocaine and benzoylecgonine mass loads were also 40 times higher downstream of the festival (1.3-4.2 mg/h vs 50.4 mg/h; p < .01) (22.7-81.4 mg/h vs 854.6 mg/h; p < .01). MDMA reached its highest level during the weekend after the festival with a concentration of 322 ng/L. This concentration is deemed harmful to aquatic life using Risk Quotient assessment (RQ) and provides evidence of continuous release after the festival due to leaching of MDMA from the site. Cocaine and benzoylecgonine concentrations were not at levels deemed harmful to aquatic life according to RQ assessment yet were three times higher than MDMA concentrations. Redlake River experienced no significant changes (p > .05) in any illicit drug levels, further confirming that drug release was likely dependent on the festival site. The release of environmentally damaging levels of illicit drugs into Whitelake River during the period of Glastonbury Festival suggests an underreported potential source of environmental contamination from greenfield festival sites.

Deep instability of deforested tropical peatlands revealed by fluvial organic carbon fluxes.

Tropical peatlands contain one of the largest pools of terrestrial organic carbon, amounting to about 89,000 teragrams (1 Tg is a billion kilograms). Approximately 65 per cent of this carbon store is in Indonesia, where extensive anthropogenic degradation in the form of deforestation, drainage and fire are converting it into a globally significant source of atmospheric carbon dioxide. Here we quantify the annual export of fluvial organic carbon from both intact peat swamp forest and peat swamp forest subject to past anthropogenic disturbance. We find that the total fluvial organic carbon flux from disturbed peat swamp forest is about 50 per cent larger than that from intact peat swamp forest. By carbon-14 dating of dissolved organic carbon (which makes up over 91 per cent of total organic carbon), we find that leaching of dissolved organic carbon from intact peat swamp forest is derived mainly from recent primary production (plant growth). In contrast, dissolved organic carbon from disturbed peat swamp forest consists mostly of much older (centuries to millennia) carbon from deep within the peat column. When we include the fluvial carbon loss term, which is often ignored, in the peatland carbon budget, we find that it increases the estimate of total carbon lost from the disturbed peatlands in our study by 22 per cent. We further estimate that since 1990 peatland disturbance has resulted in a 32 per cent increase in fluvial organic carbon flux from southeast Asia--an increase that is more than half of the entire annual fluvial organic carbon flux from all European peatlands. Our findings emphasize the need to quantify fluvial carbon losses in order to improve estimates of the impact of deforestation and drainage on tropical peatland carbon balances.

Development of User-Friendly Wearable Electronic Textiles for Healthcare Applications.

This paper presents research into a user-friendly electronic sleeve (e-sleeve) with integrated electrodes in an array for wearable healthcare. The electrode array was directly printed onto an everyday clothing fabric using screen printing. The fabric properties and designed structures of the e-sleeve were assessed and refined through interaction with end users. Different electrode array layouts were fabricated to optimize the user experience in terms of comfort, effectivity and ease of use. The e-sleeve uses dry electrodes to facilitate ease of use and the electrode array can survive bending a sufficient number of times to ensure an acceptable usage lifetime. Different cleaning methods (washing and wiping) have been identified to enable reuse of the e-sleeve after contamination during use. The application of the e-sleeve has been demonstrated via muscle stimulation on the upper limb to achieve functional tasks (e.g., hand opening, pointing) for eight stroke survivors.

Exotic Spartina alterniflora invasion alters ecosystem-atmosphere exchange of CH4 and N2O and carbon sequestration in a coastal salt marsh in China.

Coastal salt marshes are sensitive to global climate change and may play an important role in mitigating global warming. To evaluate the impacts of Spartina alterniflora invasion on global warming potential (GWP) in Chinese coastal areas, we measured CH4 and N2O fluxes and soil organic carbon sequestration rates along a transect of coastal wetlands in Jiangsu province, China, including open water; bare tidal flat; and invasive S. alterniflora, native Suaeda salsa, and Phragmites australis marshes. Annual CH4 emissions were estimated as 2.81, 4.16, 4.88, 10.79, and 16.98 kg CH4 ha(-1) for open water, bare tidal flat, and P. australis, S. salsa, and S. alterniflora marshes, respectively, indicating that S. alterniflora invasion increased CH4 emissions by 57-505%. In contrast, negative N2O fluxes were found to be significantly and negatively correlated (P < 0.001) with net ecosystem CO2 exchange during the growing season in S. alterniflora and P. australis marshes. Annual N2O emissions were 0.24, 0.38, and 0.56 kg N2O ha(-1) in open water, bare tidal flat and S. salsa marsh, respectively, compared with -0.51 kg N2O ha(-1) for S. alterniflora marsh and -0.25 kg N2O ha(-1) for P. australis marsh. The carbon sequestration rate of S. alterniflora marsh amounted to 3.16 Mg C ha(-1) yr(-1) in the top 100 cm soil profile, a value that was 2.63- to 8.78-fold higher than in native plant marshes. The estimated GWP was 1.78, -0.60, -4.09, and -1.14 Mg CO2 eq ha(-1) yr(-1) in open water, bare tidal flat, P. australis marsh and S. salsa marsh, respectively, but dropped to -11.30 Mg CO2 eq ha(-1) yr(-1) in S. alterniflora marsh. Our results indicate that although S. alterniflora invasion stimulates CH4 emissions, it can efficiently mitigate increases in atmospheric CO2 and N2O along the coast of China.

Substrate sources regulate spatial variation of metabolically active methanogens from two contrasting freshwater wetlands.

There is ample evidence that methane (CH4) emissions from natural wetlands exhibit large spatial variations at a field scale. However, little is known about the metabolically active methanogens mediating these differences. We explored the spatial patterns in active methanogens of summer inundated Calamagrostis angustifolia marsh with low CH4 emissions and permanently inundated Carex lasiocarpa marsh with high CH4 emissions in Sanjiang Plain, China. In C. angustifolia marsh, the addition of (13)C-acetate significantly increased the CH4 production rate, and Methanosarcinaceae methanogens were found to participate in the consumption of acetate. In C. lasiocarpa marsh, there was no apparent increase in the CH4 production rate and no methanogen species were labeled with (13)C. When (13)CO2-H2 was added, however, CH4 production was found to be due to Fen Cluster (Methanomicrobiales) in C. angustifolia marsh and Methanobacterium Cluster B (Methanobacteriaceae) together with Fen Cluster in C. lasiocarpa marsh. These results suggested that CH4 was produced primarily by hydrogenotrophic methanogens using substrates mainly derived from plant litter in C. lasiocarpa marsh and by both hydrogenotrophic and acetoclastic methanogens using substrates mainly derived from root exudate in C. angustifolia marsh. The significantly lower CH4 emissions measured in situ in C. angustifolia marsh was primarily due to a deficiency of substrates compared to C. lasiocarpa marsh. Therefore, we speculate that the substrate source regulates both the type of active methanogens and the CH4 production pathway and consequently contributes to the spatial variations in CH4 productions observed in these freshwater marshes.

Heavy Rainfall Impacts on Trihalomethane Formation in Contrasting Northwestern European Potable Waters.

There is emerging concern over the impact of extreme events such as heavy rainfall on the quality of water entering the drinking water supply from aboveground sources, as such events are expected to increase in magnitude and frequency in response to climate change. We compared the impact of rainfall events on streamwater quality in four contrasting upland (peatland and mineral soil) and lowland agricultural catchments used to supply drinking water in France (Brittany) and the United Kingdom (North Wales) by analyzing water samples collected before, during, and after specific events. At all four streams, heavy rainfall led to a considerable rise in organic matter concentration ranging from 48 to 158%. Dissolved organic carbon (DOC) quality, as determined using specific ultraviolet absorbance, changed consistently at all sites during rainfall events, with a greater proportion of aromatic and higher molecular weight compounds following the onset of rainfall. However, the change in DOC quality and quantity did not significantly alter the trihalomethane formation potential. We observed small increases in trihalomethane (THM) generation only at the Welsh peatland and agricultural sites and a small decrease at the Brittany agricultural site. The proportion of brominated THMs in chlorinated waters was positively correlated with bromide/DOC ratio in raw waters for all sites and hydrological conditions. These results provide a first indication of the potential implications for surface-based drinking water resources resulting from expected future increases in rainfall event intensity and extension of dry periods with climate changes.

The application of precisely controlled functional electrical stimulation to the shoulder, elbow and wrist for upper limb stroke rehabilitation: a feasibility study.

BACKGROUND: Functional electrical stimulation (FES) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke. Reduction in impairment is strongly associated with how closely FES assists performance, with advanced iterative learning control (ILC) technology providing precise upper-limb assistance. The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke. METHODS: Five stroke participants with established hemiplegia undertook eighteen intervention sessions, each of one hour duration. During each session FES was applied to the anterior deltoid, triceps, and wrist/finger extensors to assist performance of functional tasks with real-objects, including closing a drawer and pressing a light switch. Advanced model-based ILC controllers used kinematic data from previous attempts at each task to update the FES applied to each muscle on the subsequent trial. This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant. Kinematic data were collected using a Microsoft Kinect, and mechanical arm support was provided by a SaeboMAS. Participants completed Fugl-Meyer and Action Research Arm Test clinical assessments pre- and post-intervention, as well as FES-unassisted tasks during each intervention session. RESULTS: Fugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points. Improvements were also found in FES-unassisted performance, and the amount of arm support required to successfully perform the tasks was reduced. CONCLUSIONS: This feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke.

Changes in bacterial communities during rice cultivation remove phenolic constraints on peatland carbon preservation.

Northern peatlands contain ~30% of terrestrial carbon (C) stores, but in recent decades, 14% to 20% of the stored C has been lost because of conversion of the peatland to cropland. Microorganisms are widely acknowledged as primary decomposers, but the keystone taxa within the bacterial community regulating C loss from cultivated peatlands remain largely unknown. In this study, we investigated the bacterial taxa driving peat C mineralization during rice cultivation. Cultivation significantly decreased concentrations of soil organic C, dissolved organic C (DOC), carbohydrates, and phenolics but increased C mineralization rate (CMR). Consistent with the classic theory that phenolic inhibition creates a "latch" that reduces peat C decomposition, phenolics were highly negatively correlated with CMR in cultivated peatlands, indicating that elimination of inhibitory phenolics can accelerate soil C mineralization. Bacterial communities were significantly different following peatland cultivation, and co-occurrence diagnosis analysis revealed substantial changes in network clusters of closely connected nodes (modules) and bacterial keystone taxa. Specifically, in cultivated peatlands, bacterial modules were significantly negatively correlated with phenolics, carbohydrates, and DOC. While keystone taxa Xanthomonadales, Arthrobacter, and Bacteroidetes_vadinHA17 can regulate bacterial modules and promote carbon mineralization. Those observations indicated that changes in bacterial modules can promote phenolic decomposition and eliminate phenolic inhibition of labile C decomposition, thus accelerating soil organic C loss during rice cultivation. Overall, the study provides deeper insights into microbe-driven peat C loss during rice cultivation and highlights the crucial role of keystone bacterial taxa in the removal of phenolic constraints on peat C preservation.

A hybrid orthosis combining functional electrical stimulation and soft robotics for improved assistance of drop-foot.

Drop-foot is characterised by an inability to lift the foot, and affects an estimated 3 million people worldwide. Current treatment methods include rigid splints, electromechanical systems, and functional electrical stimulation (FES). However, these all have limitations, with electromechanical systems being bulky and FES leading to muscle fatigue. This paper addresses the limitations with current treatments by developing a novel orthosis combining FES with a pneumatic artificial muscle (PAM). It is the first system to combine FES and soft robotics for application to the lower limb, as well as the first to employ a model of their interaction within the control scheme. The system embeds a hybrid controller based on model predictive control (MPC), which combines FES and PAM components to optimally balance gait cycle tracking, fatigue reduction and pressure demands. Model parameters are found using a clinically feasible model identification procedure. Experimental evaluation using the system with three healthy subjects demonstrated a reduction in fatigue compared with the case of only using FES, which is supported by numerical simulation results.

Anemia detection through non-invasive analysis of lip mucosa images.

This paper aims to detect anemia using images of the lip mucosa, where the skin tissue is thin, and to confirm the feasibility of detecting anemia noninvasively and in the home environment using machine learning (ML). Data were collected from 138 patients, including 100 women and 38 men. Six ML algorithms: artificial neural network (ANN), decision tree (DT), k-nearest neighbors (KNN), logistic regression (LR), naive bayes (NB), and support vector machine (SVM) which are widely used in medical applications, were used to classify the collected data. Two different data types were obtained from participants' images (RGB red color values and HSV saturation values) as features, with age, sex, and hemoglobin levels utilized to perform classification. The ML algorithm was used to analyze and classify images of the lip mucosa quickly and accurately, potentially increasing the efficiency of anemia screening programs. The accuracy, precision, recall, and F-measure were evaluated to assess how well ML models performed in predicting anemia. The results showed that NB reported the highest accuracy (96%) among the other ML models used. DT, KNN and ANN reported an accuracies of (93%), while LR and SVM had an accuracy of (79%) and (75%) receptively. This research suggests that employing ML approaches to identify anemia will help classify the diagnosis, which will then help to create efficient preventive measures. Compared to blood tests, this noninvasive procedure is more practical and accessible to patients. Furthermore, ML algorithms may be created and trained to assess lip mucosa photos at a minimal cost, making it an affordable screening method in regions with a shortage of healthcare resources.

Corrigendum: Anemia detection through non-invasive analysis of lip mucosa images.

[This corrects the article DOI: 10.3389/fdata.2023.1241899.].

Corrigendum: Non-invasive detection of anemia using lip mucosa images transfer learning convolutional neural networks.

[This corrects the article DOI: 10.3389/fdata.2023.1291329.].

A scoping review of health system guidelines for pharmacist responsibilities when dispensing opioids.

Introduction: Prescription opioid use and evidence of the harm caused by these medicines has increased over the past 20-30 years. Despite a number of system level interventions, the opioid crisis has not yet resolved in Australia or globally. Pharmacists are increasingly required to take a proactive, clinical role to fulfil their responsibility for patient outcomes relating to both medication efficacy and safety. Aim: To evaluate the current health system guidelines available to pharmacists dispensing opioids and to examine the implications of this guidance on pharmacist responsibility. Methods: A scoping review was conducted by searching in CINAHL, MEDLINE, Embase, PubMed and Web of Science, in addition to the grey literature and referral from topic experts to collate a list of current health system guidelines relevant to pharmacists dispensing opioids. These guidelines were then examined through thematic analysis and the use of the "Appraisal of Guidelines Research & Evaluation-Health Systems" tool (AGREE-HS). Results: Ten health system guidelines were identified in the search. Identified guidelines were published in Australia, the United States, and the United Kingdom. Health system guidelines analysed in this study most commonly provide general practice statements that are not specific to opioid medicines. Current guidelines frequently recommend risk assessment, but less commonly provide implementable risk mitigation advice. Additionally, guidelines are of poor overall quality when analysed through metrics relating to their development and implementation. Conclusion: There are gaps in current health system guidelines which contribute to perceived barriers in pharmacy practice. Current health system guidance does not provide a clear account of the responsibilities of pharmacists when dispensing opioids. This study provides an argument for the development of implementable health system guidelines that support pharmacists in taking direct responsibility for patient outcomes when dispensing opioid medicines.

Agricultural land use regulates the fate of soil phosphorus fractions following the reclamation of wetlands.

Over half of the Earth's wetlands have been reclaimed for agriculture, leading to significant soil P destabilization and leaching risks. To evaluate the effects of agricultural land use on soil P stability, we used sequential P extraction to investigate the long-term effects of wetland cultivation for rice and soybean on soil P fractions, including labile and moderately labile inorganic/organic P (LPi, LPo, MPi, and MPo), and stable P in Northeast China. The results showed that soybean cultivation decreased the total P by 35.9 %, whereas rice cultivation did not influence the total P content (p < 0.05). Both the soybean and rice cultivations significantly increased LPi (p < 0.05). Soybean cultivation significantly decreased the LPo and MPo compared to rice cultivation, and the latter increased MPi by 309.28 % compared with the reference wetlands (p < 0.05). Redundancy analysis indicated that pH, poorly crystalline Fe (Feca), crystalline Fe (Fec), and total organic carbon (TOC) explained similar variations in P fractions during soybean and rice cultivation (54.9 % and 49.7 %, respectively). Similarly, during soybean or rice cultivation, pH negatively influenced LPo and MPo, while Feca positively influenced MPi and LPi. Furthermore, TOC showed a positive role in LPo, and MPo, but a negative effect on LPi and MPi during rice cultivation. Hence, we concluded that the cultivation of soybean or rice create contrasting modifications to wetland soil P fractionation by altering TOC, Feca, Fec, and pH. Our study indicates that agricultural land use can regulate the fate of wetland soil P fractionation, with potential benefits to both i) P risk management in cultivated wetlands and ii) potential approaches for future wetland restoration.

RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice.

BACKGROUND: Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies. METHODS: DESIGN: 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. SETTING: primary care general practices in southeast Queensland, Australia. POPULATION: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. INTERVENTION: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. OUTCOME MEASURES: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. SECONDARY OUTCOMES: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. SAMPLE SIZE: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity). DISCUSSION: The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients. TRIAL REGISTRATION: ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

Functional electrical stimulation mediated by iterative learning control and 3D robotics reduces motor impairment in chronic stroke.

BACKGROUND: Novel stroke rehabilitation techniques that employ electrical stimulation (ES) and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients' voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work using advanced ES controllers, and aims to investigate the feasibility of Stimulation Assistance through Iterative Learning (SAIL), a novel upper limb stroke rehabilitation system which utilises robotic support, ES, and voluntary effort. METHODS: Five hemiparetic, chronic stroke participants with impaired upper limb function attended 18, 1 hour intervention sessions. Participants completed virtual reality tracking tasks whereby they moved their impaired arm to follow a slowly moving sphere along a specified trajectory. To do this, the participants' arm was supported by a robot. ES, mediated by advanced iterative learning control (ILC) algorithms, was applied to the triceps and anterior deltoid muscles. Each movement was repeated 6 times and ILC adjusted the amount of stimulation applied on each trial to improve accuracy and maximise voluntary effort. Participants completed clinical assessments (Fugl-Meyer, Action Research Arm Test) at baseline and post-intervention, as well as unassisted tracking tasks at the beginning and end of each intervention session. Data were analysed using t-tests and linear regression. RESULTS: From baseline to post-intervention, Fugl-Meyer scores improved, assisted and unassisted tracking performance improved, and the amount of ES required to assist tracking reduced. CONCLUSIONS: The concept of minimising support from ES using ILC algorithms was demonstrated. The positive results are promising with respect to reducing upper limb impairments following stroke, however, a larger study is required to confirm this.