Age-specific information resources to address the needs of young people with stroke: a scoping review protocol.

BACKGROUND AND AIMS: Young people with stroke (YPwS) persistently experience challenges with disability, social reintegration, employment, and financial stability to provide for themselves and their families. The aims of this scoping review are to (1) identify and collate information resources for YPwS and evidence-based self-managements programs and (2) identify gaps in age-specific resources available for YPwS after traditional rehabilitation services have ended and/or who are returning to live in the community. METHODS: We will include both qualitative and quantitative studies, including all study designs. Participants will be community-dwelling adults aged between 18 and 65 years with a clinical diagnosis of stroke. We will include information resources and evidence-based self-managements programs for YPwS. Search terms will include stroke, young people, and community dwelling. We will search electronic databases such as MEDLINE. The reference lists of included studies, systematic reviews, and stroke guidelines and stroke-specific websites will also be searched. We will also contact Stroke Support Organizations and international/national allied health professional organisations to gather information resources about YPwS. We will also conduct a comprehensive environmental scan of additional resources using the search engine Google. The titles, abstracts, full-text articles, and contents of the resources identified by the search will be assessed against the inclusion and exclusion criteria to identify potentially relevant resources. RESULTS AND CONCLUSIONS: Existing resources and self-management programs will be collated and categorized according to the type of needs addressed such as physical, emotions, activities of daily living, information, relationships, and social needs as well as the key gaps identified.

Nitrogen processing by treatment wetlands in a tropical catchment dominated by agricultural landuse.

Agriculture is a major contributor to marine nitrogen pollution, and treatment wetlands can be a strategy to reduce it. However, few studies have assessed the potential of treatment wetlands to mitigate nitrogen pollution in tropical regions. We quantify the nitrogen removal rates of four recently constructed treatment wetlands in tropical Australia. We measured denitrification potential (Dt), the inflow-outflow of nutrients, and tested whether the environment in these tropical catchments is favourable for nitrogen removal. Dt was detected in three of the four systems with rates between 2.0 and 12.0 mg m-2 h-1; the highest rates were measured in anoxic soils (ORP -100 to 300 mV) that were rich in carbon and nitrogen (>2% and >0.2%, respectively). The highest nitrogen removal rates were measured when NO3--N concentrations were >0.4 mg L-1 and when water flows were slow. Treatment wetlands in tropical regions can deliver high removal rates of nitrogen and other pollutants when adequately managed. This strategy can reduce nutrient loads and their impacts on sensitive coastal zones such as the Great Barrier Reef.

Best practice for arm recovery post stroke: an international application.

OBJECTIVE: To develop an evidence-based application ('app') for post-stroke upper extremity rehabilitation that can be used globally by therapists. PARTICIPANTS: Twenty-three experienced neurorehabilitation therapists, applied scientists and physicians, and 10 consultants dedicated to the provision of best practice to stroke survivors. DESIGN: This team evaluated the evidence to support the timely and appropriate provision of interventions and the most defensible outcome measures during a 4-year voluntary information gathering and assimilation effort, as a basis for the sequencing of an algorithm informed by the data and directed by changes in impairment and chronicity. OUTCOME MEASURES: The primary outcome was the formulation of a testable app that will be available for minimal user cost. The app is for a smartphone, and the comments of a focus group (audience at a World Confederation for Physical Therapy 2015 presentation, approximate n=175) during a 30-minute 'Questions and Answers' session were assessed. RESULTS: Analysis of documented, extensive input offered by the audience indicated a highly favourable disposition towards this novel tool, with provision of concrete suggestions prior to launching the final version. Suggestions centred on: inclusion of instructions; visuals and demonstrations; monitoring of adverse responses; availability of updates; autonomous use by patients; and potential to characterise practice. CONCLUSIONS: A simple, user-friendly app for decision making in the treatment of upper extremity impairments following stroke is feasible and welcomed.

Measuring oxygen uptake in fishes with bimodal respiration.

Respirometry is a robust method for measurement of oxygen uptake as a proxy for metabolic rate in fishes, and how species with bimodal respiration might meet their demands from water v. air has interested researchers for over a century. The challenges of measuring oxygen uptake from both water and air, preferably simultaneously, have been addressed in a variety of ways, which are briefly reviewed. These methods are not well-suited for the long-term measurements necessary to be certain of obtaining undisturbed patterns of respiratory partitioning, for example, to estimate traits such as standard metabolic rate. Such measurements require automated intermittent-closed respirometry that, for bimodal fishes, has only recently been developed. This paper describes two approaches in enough detail to be replicated by the interested researcher. These methods are for static respirometry. Measuring oxygen uptake by bimodal fishes during exercise poses specific challenges, which are described to aid the reader in designing experiments. The respiratory physiology and behaviour of air-breathing fishes is very complex and can easily be influenced by experimental conditions, and some general considerations are listed to facilitate the design of experiments. Air breathing is believed to have evolved in response to aquatic hypoxia and, probably, associated hypercapnia. The review ends by considering what realistic hypercapnia is, how hypercapnic tropical waters can become and how this might influence bimodal animals' gas exchange.

Increased temperature tolerance of the air-breathing Asian swamp eel Monopterus albus after high-temperature acclimation is not explained by improved cardiorespiratory performance.

This study investigated the hypothesis that in the Asian swamp eel Monopterus albus, an air-breathing fish from south-east Asia that uses the buccopharyngeal cavity for oxygen uptake, the upper critical temperature (TU) is increased by acclimation to higher temperature, and that the increased TU is associated with improved cardiovascular and respiratory function. Monopterus albus were therefore acclimated to 27° C (current average) and 32° C (current maximum temperature as well as projected average within 100-200 years), and both the effect of acclimation and acute temperature increments on cardiovascular and respiratory functions were investigated. Two weeks of heat acclimation increased upper tolerated temperature (TU ) by 2° C from 36·9 ± 0·1° C to 38·9 ± 0·1° C (mean ± s.e.). Oxygen uptake (M˙O2) increased with acclimation temperature, accommodated by increases in both aerial and aquatic respiration. Overall, M˙O2 from air (M˙O2a ) was predominant, representing 85% in 27° C acclimated fish and 80% in 32° C acclimated fish. M˙O2 increased with acute increments in temperature and this increase was entirely accommodated by an increase in air-breathing frequency and M˙O2a . Monopterus albus failed to upregulate stroke volume; rather, cardiac output was maintained through increased heart rate with rising temperature. Overall, acclimation of M. albus to 32° C did not improve its cardiovascular and respiratory performance at higher temperatures, and cardiovascular adaptations, therefore, do not appear to contribute to the observed increase in TU.

Do measures of reactive balance control predict falls in people with stroke returning to the community?

OBJECTIVE: To determine if reactive balance control measures predict falls after discharge from stroke rehabilitation. DESIGN: Prospective cohort study. SETTING: Rehabilitation hospital and community. PARTICIPANTS: Independently ambulatory individuals with stroke who were discharged home after inpatient rehabilitation (n=95). MAIN OUTCOME MEASURES: Balance and gait measures were obtained from a clinical assessment at discharge from inpatient stroke rehabilitation. Measures of reactive balance control were obtained: (1) during quiet standing; (2) when walking; and (3) in response to large postural perturbations. Participants reported falls and activity levels up to 6 months post-discharge. Logistic and Poisson regressions were used to identify measures of reactive balance control that were related to falls post-discharge. RESULTS: Decreased paretic limb contribution to standing balance control [rate ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0; P=0.011], reduced between-limb synchronisation of quiet standing balance control (rate ratio 0.9, 95% CI 0.8 to 0.9; P<0.0001), increased step length variability (rate ratio 1.4, 95% CI 1.2 to 1.7; P=0.0011) and inability to step with the blocked limb (rate ratio 1.2, 95% CI 1.0 to 1.3; P=0.013) were significantly associated with increased fall rates when controlling for age, stroke severity, functional balance and daily walking activity. CONCLUSIONS: Impaired reactive balance control in standing and walking predicted increased risk of falls post-discharge from stroke rehabilitation. Specifically, measures that revealed the capacity of both limbs to respond to instability were related to increased risk of falls. These results suggest that post-stroke rehabilitation strategies for falls prevention should train responses to instability, and focus on remediating dyscontrol in the more-affected limb.

Effect of salinity on oxygen consumption in fishes: a review.

The effect of salinity on resting oxygen uptake was measured in the perch Perca fluviatilis and available information on oxygen uptake in teleost species at a variety of salinities was reviewed. Trans-epithelial ion transport against a concentration gradient requires energy and exposure to salinities osmotically different from the body fluids therefore imposes an energetic demand that is expected to be lowest in brackish water compared to fresh and sea water. Across species, there is no clear trend between oxygen uptake and salinity, and estimates of cost of osmotic and ionic regulation vary from a few per cent to >30% of standard metabolism.

Air-breathing fishes in aquaculture. What can we learn from physiology?

During the past decade, the culture of air-breathing fish species has increased dramatically and is now a significant global source of protein for human consumption. This development has generated a need for specific information on how to maximize growth and minimize the environmental effect of culture systems. Here, the existing data on metabolism in air-breathing fishes are reviewed, with the aim of shedding new light on the oxygen requirements of air-breathing fishes in aquaculture, reaching the conclusion that aquatic oxygenation is much more important than previously assumed. In addition, the possible effects on growth of the recurrent exposure to deep hypoxia and associated elevated concentrations of carbon dioxide, ammonia and nitrite, that occurs in the culture ponds used for air-breathing fishes, are discussed. Where data on air-breathing fishes are simply lacking, data for a few water-breathing species will be reviewed, to put the physiological effects into a growth perspective. It is argued that an understanding of air-breathing fishes' respiratory physiology, including metabolic rate, partitioning of oxygen uptake from air and water in facultative air breathers, the critical oxygen tension, can provide important input for the optimization of culture practices. Given the growing importance of air breathers in aquaculture production, there is an urgent need for further data on these issues.

The 100 most cited papers in foot and ankle surgery.

BACKGROUND: The number of citations of a paper gives an indication of an article's merit and importance within a medical specialty. We identify and analyse the 100 most cited papers in foot and ankle surgery. METHOD: The Science Citation Index Expanded was searched for citations in 15 respected journals containing foot and ankle articles. Papers were analysed for subject, authorship, institution, country and year of publication. The average yearly citation was compared to total number of citations. RESULTS: 3501 foot and ankle papers were returned. The maximum number of citations was 1084 and the mean was 104. The top 100 papers were published between 1979 and 2007, with the majority published in the last decade. The ankle was the most important anatomical region discussed, and basic science and degenerative disease were popular topics. We found a large discrepancy between the total number of citations with average yearly citation. CONCLUSION: Foot and ankle surgery is a young and rapidly developing sub-specialty within orthopaedics. Recently there has been a significant increase in influential papers published. Certain topics are popular indicating their importance within the field. This study highlights important papers in foot and ankle surgery giving an insight into readership.

The Canadian Heart Health Strategy and Action Plan: Cardiac rehabilitation as an exemplar of chronic disease management.

BACKGROUND: In October 2006, federal funding was announced for the development of a national strategy to fight cardiovascular disease (CVD) in Canada. The comprehensive, independent, stakeholder-driven Canadian Heart Health Strategy and Action Plan (CHHS-AP) was delivered to the Minister of Health on February 24, 2009. OBJECTIVES: The mandate of CHHS-AP Theme Working Group (TWG) 6 was to identify the optimal chronic disease management model that incorporated timely access to rehabilitation services and end-of-life planning and care. The purpose of the present paper was to provide an overview of worldwide approaches to CVD and cardiac rehabilitation (CR) strategies and recommendations for CR care in Canada, within the context of the well-known Chronic Care Model (CCM). A separate paper will address end-of-life issues in CVD. METHODS: TWG 6 was composed of content representatives, primary care representatives and patients. Input in the area of Aboriginal and indigenous cardiovascular health was obtained through individual expert consultation. Information germane to the present paper was gathered from international literature and best practice guidelines. The CCM principles were discussed and agreed on by all. Prioritization of recommendations and overall messaging was discussed and decided on within the entire TWG. The full TWG report was presented to the CHHS-AP Steering Committee and was used to inform the recommendations of the CHHS-AP. RESULTS: Specific actionable recommendations for CR are made in accordance with the key principles of the CCM. CONCLUSIONS: The present CR blueprint, as part of the CHHS-AP, will be a first step toward reducing the health care burden of CVD in Canada.

Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the Wii gaming system.

BACKGROUND: Evidence suggests that increasing intensity of rehabilitation results in better motor recovery. Limited evidence is available on the effectiveness of an interactive virtual reality gaming system for stroke rehabilitation. EVREST was designed to evaluate feasibility, safety and efficacy of using the Nintendo Wii gaming virtual reality (VRWii) technology to improve arm recovery in stroke patients. METHODS: Pilot randomized study comparing, VRWii versus recreational therapy (RT) in patients receiving standard rehabilitation within six months of stroke with a motor deficit of > or =3 on the Chedoke-McMaster Scale (arm). In this study we expect to randomize 20 patients. All participants (age 18-85) will receive customary rehabilitative treatment consistent of a standardized protocol (eight sessions, 60 min each, over a two-week period). OUTCOME MEASURES: The primary feasibility outcome is the total time receiving the intervention. The primary safety outcome is the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, will be measured by the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at the four-week follow-up visit. From November, 2008 to September, 2009 21 patients were randomized to VRWii or RT. Mean age, 61 (range 41-83) years. Mean time from stroke onset 25 (range 10-56) days. CONCLUSIONS: EVREST is the first randomized parallel controlled trial assessing the feasibility, safety, and efficacy of virtual reality using Wii gaming technology in stroke rehabilitation. The results of this study will serve as the basis for a larger multicentre trial. ClinicalTrials.gov registration# NTC692523.

Is there a trade-off between cognitive and motor recovery after traumatic brain injury due to competition for limited neural resources?

The status of neurorehabilitation for traumatic brain injury (TBI) is under active debate because of a dearth of research findings demonstrating effectiveness. This may be due, in part, to limitations in our understanding of basic mechanisms of cognitive and motor recovery,including those that might impede recovery. In this regard, we examined whether overall recovery following TBI might be undermined by competition between cognitive and motor functions for finite neural resources during recovery. In this preliminary study, 21 moderately and severely impaired patients were administered cognitive and motor assessments at 1, 4, and 12 months post-TBI, and recovery of cognitive and motor functions was measured using regression residuals. Negative correlations between recovery of cognitive versus motor functions were used as the index of competition. We found suggestive evidence that there may indeed be a trade-off between the recovery of cognitive and motor functions after TBI. Implications for rehabilitation are discussed.

Genetic and morphological diversity in populations of Nucella lapillus (L.; neogastropoda) in response to tributyltin contamination.

During the past three decades, North Atlantic populations of dogwhelks have been severely reduced in numbers, due to imposex and female sterility caused by TBT. We examined the relationship between the known history of female sterility and the present genetic diversity (measured by five allozyme-loci) and phenotypic variance (measured by nine quantitative characters) in six populations of Nucella lapillus along the coast of Norway. The environment of one of the populations was severely polluted with a vas deferens sequence index (VDSI) of 4.31, resulting in 24% sterile females. The environment of four of the other five populations was moderately polluted (VDSI 3.31-3.97, 0-1.6% sterile females), while the last population was unpolluted (VDSI 0.02, 0% sterile females). The six populations did not differ significantly with respect to genetic diversity. However, the population from the most polluted area had greater phenotypic variation in shell size, compared to all other populations. The results indicate that although TBT has had severe local negative effects on N. lapillus populations, it has not caused a reduction in long-term adaptive potential.

Issues for selection of outcome measures in stroke rehabilitation: ICF activity.

PURPOSE: To evaluate the psychometric and administrative properties of outcome measures in the WHO International Classification of Functioning, Disability and Health (ICF) Activity category used in stroke rehabilitation research and reported in the published literature. METHOD: Critical review and synthesis of measurement properties for nine commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature. RESULTS: The reporting of specific measurement qualities for outcome instruments was relatively consistent across measures located within the same general ICF category. There was evidence to suggest that the measures were responsive to change as well as being valid and reliable tools. The best available instruments were associated with the assessment of activities of daily living, balance (static and dynamic), functional independence, and functional mobility. CONCLUSIONS: Given the diversity that exists among available measures, the reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved functional activity in stroke rehabilitation. However, there appears to be good consensus regarding the most important indicators of successful rehabilitation outcome, especially in the case of functional mobility.

Issues for selection of outcome measures in stroke rehabilitation: ICF Participation.

PURPOSE: To evaluate the psychometric and administrative properties of outcome measures in the ICF Participation category, which are used in stroke rehabilitation research and reported in the published literature. METHOD: Critical review and synthesis of measurement properties for six commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature. RESULTS: Validity has been well reported for at least half of the measures reviewed. However, methods for reporting specific measurement qualities of outcome instruments were inconsistent. Responsiveness of measures has not been well documented. Of the three ICF categories, Participation seems to be most problematic with respect to: (a) lack of consensus on the range of domains required for measurement in stroke; (b) much greater emphasis on health-related quality of life, relative to subjective quality of life in general; (c) the inclusion of a mixture of measurements from all three ICF categories. CONCLUSIONS: The reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved participation associated with stroke rehabilitation. There is no consensus regarding the most important indicators of successful involvement in a life situation and which ones best represent the societal perspective of functioning. In particular, quality of life outcomes lack adequate conceptual frameworks to guide the process of development and validation of measures.

Nitrogen removal from domestic effluent using subsurface flow constructed wetlands: influence of depth, hydraulic residence time and pre-nitrification.

This paper describes two studies into the BOD and TN removal performance of horizontal subsurface flow wetlands (reed beds) in subtropical Australia. The aim of the first study was to determine the influence of HRT and vertical position on BOD and TN concentration and removal performance in a 0.5 m deep reed bed (System 1) by taking samples from three levels (or layers) in the water column at five points along the length of the bed. The aim of the second study was to investigate the TN removal performance of a treatment train consisting of a vertical flow intermittently dosed sand filter preceding a reed bed (System 2). Both systems were dosed with primary settled municipal wastewater (BOD 194 mg L(-1); TN 49 mg L(-1)). System 1 achieved a TN load removal of 58% under a HLR of 22 mm day(-1) (HRT 10.5 days), producing effluent BOD concentrations consistently less than 8 mg L(-1). There was no significant difference in BOD attenuation rate between the three layers. While there were differences in both the nitrification and denitrification rates between the three layers, the TN concentration was found to decline steadily in all layers up to an HRT of 8.7 days. System 2 reduced TN influent load by 33%, less than half of which was removed by the reed bed. The lack of substantial TN removal within this reed bed was attributed to the low concentrations of BOD and consequent lack of dissolved organic carbon to drive the denitrification process.

Open-label study of donepezil in traumatic brain injury.

OBJECTIVE: To determine preliminarily whether donepezil will improve memory, behavior, and global function after chronic traumatic brain injury (TBI). DESIGN: Sixteen-week open-label study. SETTING: Outpatient TBI rehabilitation program. PATIENTS: Four patients with chronic, severe TBI. INTERVENTIONS: Donepezil 5mg daily for 8 weeks followed by 10mg daily for 4 weeks. MAIN OUTCOME MEASURES: Memory measures included the Rey Auditory Verbal Learning Test (RAVLT), the Complex Figure Test (CFT), items from the Rivermead Behavioural Memory Test (RBMT), and a semantic fluency task. The Neuropsychiatric Inventory (NPI) evaluated behavior and affect. Function was assessed by using the FIM instrument and a clinical global impression of change. RESULTS: On the RAVLT, the mean scores for learning and short- and long-term recall improved by 0.4, 1.04, and.83 standard deviations (SDs) above baseline, respectively. On the CFT, the mean scores for short-term recall and long-term recall improved by 1.56 and 1.38 SDs above baseline, respectively. A positive trend was observed on the RBMT and on the NPI subscales. CONCLUSIONS: Donepezil may improve some aspects of memory and behavior in persons with chronic TBI. Randomized clinical trials are required to support these preliminary findings.

Enhanced drought tolerance of a soil-dwelling springtail by pre-acclimation to a mild drought stress.

The springtail Folsomia candida has a highly permeable cuticle, but is able to survive several weeks at 98.2%RH. This corresponds to a water potential deficit of about 17bars between the environment and the normal osmotic pressure of the body fluids of this animal. Recent studies have shown a water vapour absorption mechanism by accumulation of sugars and polyols (SP) in F. candida, which explains how this species can survive dehydrating conditions. In the present study, adult F. candida were pre-acclimated at 98.2%RH to induce the accumulation of SP, and were subsequently exposed for additional desiccating conditions from 98 to 94%RH. Activity level, water content, osmotic pressure of body fluids and SP composition were investigated. After the desiccation period, the animals were rehydrated at 100%RH and survival was assessed. The results showed that F. candida survived a more severe drought stress when it had been pre-acclimated to 98.2%RH before exposure to lower humidity. This species was able to maintain hyperosmosity to the surroundings at 95.5%RH, suggesting that it can absorb water vapour down to this limit. Below this limit, trehalose levels increased while myo-inositol levels decreased. We propose that this is a change of survival strategy where F. candida at mild desiccation levels seek to retain water by colligative means (remain hyperosmotic), but at severe desiccation levels switches to an anhydrobiotic strategy.

Drought acclimation confers cold tolerance in the soil collembolan Folsomia candida.

It has been noted that both summer drought and sub-zero winter temperatures induce the synthesis of sugars and polyols in invertebrate tissues. This has led several authors to suggest that many of the adaptations, previously viewed as a response to cold, might be part of a more universal desiccation tolerance mechanism. Here we show that acclimation of the soil dwelling collembolan Folsomia candida to a sublethal desiccation stress confers tolerance to cold shock and a significant increase in the molar percent of membrane fatty acids with a mid-chain double bond. These changes in membrane fatty acids are interpreted as conferring a significant reduction in the transition temperature of cell membranes, as would be expected in acclimation to cold, and these changes are therefore interpreted as contributing to the cross-tolerance. Drought acclimation was also shown to trigger the synthesis of the 70kDa family of heat-shock proteins (Hsp70). This group of heat shock proteins is implicated in the reestablishment of the normal three-dimensional structure of partially unfolded proteins and therefore are also likely to contribute to the observed cross-tolerance. This study provides evidence that the stresses exerted by desiccation and cold at the cellular level have sufficient similarities to induce overlapping adaptations.