Dynamic Lycra® orthoses as an adjunct to arm rehabilitation after stroke: a single-blind, two-arm parallel group, randomized controlled feasibility trial.

OBJECTIVE: The aim of this study was to explore the feasibility of conducting a randomized controlled trial of dynamic Lycra® orthoses as an adjunct to arm rehabilitation after stroke and to explore the magnitude and direction of change on arm outcomes. DESIGN: This is a single-blind, two-arm parallel group, feasibility randomized controlled trial. SETTING: In-patient rehabilitation. SUBJECTS: The study participants were stroke survivors with arm hemiparesis two to four weeks after stroke receiving in-patient rehabilitation. INTERVENTIONS: Participants were randomized 2:1 to wear Lycra® gauntlets for eight hours daily for eight weeks, plus usual rehabilitation (n = 27), or to usual rehabilitation only (n = 16). MAIN MEASURES: Recruitment, retention, fidelity, adverse events and completeness of data collection were examined at 8 and 16 weeks; arm function (activity limitation; Action Research Arm Test, Motor Activity Log) and impairment (Nine-hole Peg Test, Motricity Index, Modified Tardieu Scale). Structured interviews explored acceptability. RESULTS: Of the target of 51, 43 (84%) participants were recruited. Retention at 8 weeks was 32 (79%) and 24 (56%) at 16 weeks. In total, 11 (52%) intervention group participants and 6 (50%) control group participants (odds ratio = 1.3, 95% confidence interval = 0.2 to 7.8) had improved Action Research Arm Test level by 8 weeks; at 16 weeks, this was 8 (61%) intervention and 6 (75.0%) control participants (odds ratio = 1.1, 95% confidence interval = 0.1 to 13.1). Change on other measures favoured control participants. Acceptability was influenced by 26 adverse reactions. CONCLUSION: Recruitment and retention were low, and adverse reactions were problematic. There were no indications of clinically relevant effects, but the small sample means definitive conclusions cannot be made. A definitive trial is not warranted without orthoses adaptation.

A Vicinal Electrophilic Diborylation Reaction Furnishes Doubly Boron-Doped Polycyclic Aromatic Hydrocarbons.

Ten examples of unsymmetrically benzannulated, boron-doped polycyclic aromatic hydrocarbons (B-PAHs) were prepared by a one-pot protocol using 4,5-dichloro-1,2-bis(trimethylsilyl)benzene (1), BBr3 , and selected PAHs-among them anthracene, benzo[a]pyrene, biphenylene, and fluoranthene. After mesitylation at the boron centers, the resulting air- and water-stable products were investigated by 1 H/11 B{1 H}/13 C{1 H} NMR spectroscopy, X-ray crystallography, cyclic voltammetry, and UV/Vis absorption/emission spectroscopy. The experiments were augmented by DFT calculations. Most of the B-PAHs are brightly luminescent (ΦPL up to 90 %) and undergo reversible reduction at moderate half-wave potentials. The two chloro substituents of 1 are not only mandatory for accomplishing efficient diborylation, but can subsequently be used for Stille-type coupling reactions to introduce 2-thienyl moieties. Alternatively, Cl/H exchange is achievable with HSiEt3 in a quantitative, Pd-catalyzed transformation.

"Third-Generation"-Type Functional Tris(2-pyridyl)borate Ligands and Their Transition-Metal Complexes.

Phenyltris(2-pyridyl)borates (Tpyb) are a promising class of tripodal "scorpionate"-type ligands with potential utility in the development of transition-metal complexes with interesting optical, electronic, or magnetic properties and as building blocks to metallosupramolecular polymers. We report here a new class of "third-generation"-type Tpyb ligands that contain different functional groups attached to the boron-bound aryl moiety. The synthesis, characterization, and metal-ion complexation behavior of ligands with iodo and trimethylsilyl groups are discussed. The electrochemical and absorption characteristics of the corresponding low-spin iron(II) and ruthenium(II) complexes are compared. We demonstrate the further elaboration of iodo derivatives with alkynes via Sonogashira-Hagihara coupling, a process that proceeds with high yield for the iron(II) and ruthenium(II) complexes but not for the free ligand. Borylation of the silyl-substituted ruthenium(II) complex with BBr3 was also investigated. In addition to the expected borylation product Ru(Tpyb-Bpin)2, the replacement of one (major product) or two phenyl groups is observed, suggesting that electrophilic borylation occurs at both the C(Ph)-Si and the C(Ph)-B aromatic carbon atoms. The successful attachment of a range of different functional groups at the periphery of the Tpyb metal complexes is expected to provide opportunities to access new polymeric materials via C-C coupling or click-type reactions.

Rehabilitation of older patients: day hospital compared with rehabilitation at home. Clinical outcomes.

OBJECTIVES: to test the hypothesis that older people and their informal carers are not disadvantaged by home-based rehabilitation (HBR) relative to day hospital rehabilitation (DHR). DESIGN: pragmatic randomised controlled trial. SETTING: four geriatric day hospitals and four home rehabilitation teams in England. PARTICIPANTS: eighty-nine patients referred for multidisciplinary rehabilitation. The target sample size was 460. INTERVENTION: multidisciplinary rehabilitation either in the home or in the day hospital. MEASUREMENTS: the primary outcome measure was the Nottingham extended activities of daily living scale (NEADL). Secondary outcome measures included EQ-5D, hospital anxiety and depression scale, therapy outcome measures, hospital admissions and the General Health Questionnaire for carers. RESULTS: at the primary end point of 6 months NEADL scores were not significantly in favour of HBR cf. DHR; mean difference -2.139 (95% confidence interval -6.87 to 2.59, P = 0.37). A post hoc analysis suggested non-inferiority for HBR for NEADL but there was considerable statistical uncertainty. CONCLUSION: taken together the statistical analyses and lack of power of the trial outcomes do not provide sufficient evidence to conclude that patients in receipt of HBR are disadvantaged compared with those receiving DHR.

Implementation of Dynamic Lycra® Orthoses for Arm Rehabilitation in the Context of a Randomised Controlled Feasibility Trial in Stroke: A Qualitative study Using Normalisation Process Theory.

OBJECTIVE: To explore how non-research funded rehabilitation practitioners implemented dynamic Lycra® orthoses for arm recovery after stroke into rehabilitation practice, as part of a feasibility randomised controlled trial. DESIGN: Qualitative interview study. SETTING: Two in-patient stroke units and associated rehabilitation units. SUBJECTS: Fifteen purposefully selected stroke rehabilitation practitioners involved in delivery of dynamic Lycra® orthoses as part of a feasibility randomised controlled trial. METHODS: Semi-structured interviews conducted at the end of the trial. Interviews examined their experiences of orthosis implementation. Normalisation Process Theory structured the interview guide and informed data analysis. NVivo software supported data analysis. RESULTS: Practitioners intuitively made sense of the intervention in the face of uncertainty about its precise mechanisms of action (Normalisation Process Theory construct: coherence) and espoused commitment to the research, despite uncertainty about orthosis effectiveness (cognitive participation). They did however adapt the intervention based on perceived therapeutic need, their own skillsets and stroke survivor preference (collective action). They were uncertain about benefits (reflexive monitoring). Across the 4 theoretical constructs, ambivalence about the intervention was detected. CONCLUSIONS: Ambivalence interfered with implementation - but only to an extent. 'Good-enough' coherence, cognitive participation, collective action and reflexive monitoring were sufficient to initiate normalisation - as long as implementation did not undermine the relationship between practitioner and stroke survivor. Ambivalence stemmed from practitioners' uncertainty about the intervention theory and mechanisms of action. Making intervention mechanisms of action more explicit to practitioners may influence how they implement and adapt a research intervention, and may determine whether those processes undermine or enhance outcomes.

Simultaneous expansion of 9,10 boron-doped anthracene in longitudinal and lateral directions.

Doubly boron-doped anthracenes and pentacenes have been longitudinally and laterally expanded through annulation of thiophene or benzene rings. The obtained series of closely related compounds allowed an assessment of key structure-property relationships with a focus on optoelectronic characteristics. Most of the products are benchtop-stable blue emitters and capable of accepting two electrons in a reversible manner. The syntheses involved late-stage modifications through photocyclization or stepwise oxidative C-C coupling (DDQ/BF3·Et2O) as well as cyclocondensation of ortho-disilylated or -diborylated aryl building blocks.

The self-regulatory model in women with rheumatoid arthritis: relationships between illness representations, coping strategies, and illness outcome.

OBJECTIVES: The self-regulatory model proposes that an individual's cognitive representations of illness threat (illness representations) influence the selection and performance of strategies to cope with that illness (Leventhal, Meyer, & Nerenz, 1980). Also implicit in the model is the proposal that such coping strategies influence illness outcomes. These relationships represent a mediational model (Baron & Kenny, 1986). The aim of the present study is to test the hypothesis that coping strategies partially mediate the relationship between illness representations and illness outcome in women with rheumatoid arthritis. DESIGN AND METHODS: The study is an observational cross-sectional design. Self-report measures of illness representations, coping strategies, and illness outcome were collected from 125 women with rheumatoid arthritis attending rheumatology outpatient clinics. Clinical measures of disease activity and severity were obtained from hospital records. RESULTS: Avoidant and resigned coping were found to partially mediate the relationship between symptom identity and the illness outcome measures of disability and psychiatric morbidity. As in other studies, strong relationships were found between illness representations and illness outcome. CONCLUSIONS: The finding that avoidant and resigned coping partially mediated the relationships between the illness representation dimension of symptom identity and two of the illness outcome measures (disability and psychiatric morbidity) provided some support for the hypothesis. However, the hypothesis was not fully supported, as coping did not partially mediate the relationship between any of the other illness representations and illness outcomes.

Comparing outcomes of voice therapy: a benchmarking study using the therapy outcome measure.

The quality cycle requires clinicians to assess the outcomes of interventions. Benchmarking is an approach that has been advocated to compare current performance across different services to identify commonalities and significant differences. This article gives the results of a study of outcomes in speech and language therapy (SLT) using the therapy outcome measure (TOM) for patients with voice disorder (dysphonia) comparing outcomes of seven separate speech and language therapy services. The study aimed to identify the similarities and differences in outcomes of care provided by different services. Two hundred and forty patients with dysphonia (age range 3-87.5 years, average 51.9 years) were treated. The results indicated that although there was no significant difference in the profile of the severity of symptomology of patients referred to speech and language therapy in different geographical areas, there was a significant difference in the treatment outcomes across the services and in the stated reason for discharge from treatment. Nevertheless, most patients with dysphonia had a good outcome and this was associated with completion of the course of treatment. There were significant differences in the number of treatment contacts provided by the different services and in the duration (between admission and discharge) of treatment across the services. Benchmarking can provide useful information through use of routinely collected clinical data.

Therapy outcome measures: where are we now?

Outcomes information contributes to the provision of quality services: sharing that information requires speech-language pathologists (SLPs) to use terminology readily understood by professions ranging from health and education to social and voluntary services. The Therapy Outcome Measure (TOM) provides a way of presenting outcome data in a digestible form, comprising part of a range of multiple measures used to collect information on the structures, processes, and outcomes of care. TOM was developed to provide a practical method of measuring outcomes in routine clinical practice. Furthermore, it has been used in a number of research studies as an outcome indicator. As an example of its utility in research, the article cites a benchmarking study, together with examples of internal and external benchmarking of outcomes intended to illustrate how the benchmarking of TOM data can inform practice. The TOM can therefore inform SLPs on their own outcomes, the outcomes for specific client groups, and, by benchmarking TOM data, can contribute to the delivery of better, more efficient services.

The cleft audit protocol for speech-augmented: A validated and reliable measure for auditing cleft speech.

OBJECTIVES: To develop an assessment tool for use in intercenter audit studies of cleft speech and to test its acceptability, validity, and reliability. The tool is to be used systematically to record and report speech outcomes, providing an indication of treatment needs and continuing burden of care. SETTING: Regional Cleft Center, U.K. METHODS: The Cleft Audit Protocol for Speech-Augmented (CAPS-A) was developed by three cleft speech experts who identified the key features required from existing assessment measures. Criterion validity was assessed by comparing the Cleft Audit Protocol for Speech-Augmented outcomes reported for 20 cases with clinical assessment results and other investigations. Intra- and interrater reliability were tested following the training of specialist speech and language therapists who used the Cleft Audit Protocol for Speech-Augmented on two occasions to assess 10 cases. The raters evaluated acceptability and ease of using a questionnaire. RESULTS: The mean percentage agreement for criterion validity in each section was 87% (range 70% to 100%). Both intra- and interexaminer reliability were rated as good/very good (Kappa 0.61 to 1.00) for seven sections and moderate (Kappa 0.41 to 0.60) for three sections. Raters reported that the Cleft Audit Protocol for Speech-Augmented was acceptable and easy to use with appropriate training. CONCLUSION: An acceptable, valid, and reliable cleft speech audit tool has been developed based on a small sample. The Cleft Audit Protocol for Speech-Augmented is recommended for use in intercenter audit studies in the U.K. and Ireland and could be used in other English-speaking countries. In addition, it has wider applicability for use in reporting speech outcomes of surgical procedures.

Quality of life in young people: ratings and factor structure of the Quality of Life Profile-Adolescent Version.

The purpose of the study was to provide British data relating to the 54-item Quality of Life Profile Adolescent Version (QOLPAV; Raphael et al., 1996, Journal of Adolescent Health, 19, 366-375) and to explore the underlying factor structure of the questionnaire. The relationship between demographic variables (such as social economic status, gender and ethnicity) and quality of life (QOL) were investigated. Eight hundred and ninety-nine young people aged 12-16 were recruited from secondary schools in the south of England to participate in the study. Factor analysis highlighted eight dimensions embedded within the scale, which were largely consistent with the QOL model proposed by Raphael et al. (1996, Journal of Adolescent Health, 19, 366-375). A notable exception concerned items from the subdomain of "spiritual being", which did not cluster together but dispersed across multiple factors. Exclusion of complex items and those with low loadings on subdomains resulted in a briefer scale consisting of 32 items. Of the demographic variables examined, only age was significantly associated with quality of life scores.

Absorption, distribution and excretion of 14C-pilocarpine following oral administration to rats.

The absorption, distribution and excretion of pilocarpine (CAS 92-13-7) were studied after single oral doses of 14C-pilocarpine hydrochloride (CAS 54-71-7) to the Sprague-Dawley rat, administered in aqueous solution mainly at a dose level of 0.3 mg/kg. Rats also received single intravenous doses at 0.3 mg/kg so as to compare 14C pharmacokinetics and excretion. The oral 14C-dose was rapidly and almost completely absorbed from the duodenum and small intestine within 30 min in the male rat and 14C concentrations in plasma declined biexponentially with a terminal half-life of about 9 h. Over the oral dosage range studied, i.e. 0.1-1.0 mg/kg, there was no evidence of significant non-proportionality for Cmax of 14C, whereas there was some such evidence for AUG24. Tissue 14C concentrations in male and pregnant female (Day 18) rats peaked at 0.5 h and mostly declined in parallel with those in the plasma. Excluding tissues concerned with drug absorption and elimination, 14C concentrations in most tissues were similar to, or lower than, those in the plasma. The extent of placental transfer of 14C was small and less than 0.09% of a maternal dose reached a foetus. 14C diffused into maternal milk at concentrations similar to those in the plasma. The 14C-dose was rapidly excreted in male rats, mostly in the urine (about 80%) during 6 h post dose. Recoveries of 14C in mass balance (excretion) studies were in the range 96-100%. There were no apparent gender differences in the disposition of 14C-pilocarpine in the rat.