Patients with mesothelioma and their carer's experience of diet and appetite: A qualitative insight from the Help-Meso Study.

BACKGROUND: People living with mesothelioma have a high symptom burden that can affect dietary intake and the development of malnutrition, subsequently impacting on patient-related and treatment outcomes. The present study aimed to develop a better understanding of the experiences of diet and appetite in people living with mesothelioma and their informal carers. METHODS: Twenty-three participants took part in semistructured interviews including 12 people living with mesothelioma (10 pleural and 2 peritoneal) aged 56-83 years and 12 informal carers, predominantly their spouses. Open ended questions focussed on experiences of appetite and diet, as well as approaches to maintain adequate food intake. Thematic analysis was applied. RESULTS: Four themes were generated that included unintentional weight loss and poor appetite during diagnosis and when undergoing medical intervention. Participants managed their appetite and diet by taking each day at a time and this was influenced by the physical and emotional experiences of mesothelioma. The informal carer took on the lead role of managing their relatives' diet and implemented their own nutritional strategies and there were challenges with dietary advice. CONCLUSIONS: Appetite was viewed as a multidimensional experience and was grounded within the biopsychosocial model. The findings offer important insights into opportunities informing the development of effective interventions that provide meaningful benefits for individuals living with mesothelioma and their family.

The Uses and Effectiveness of Occupational Therapy Physical Activity Interventions in Young Children with Developmental Disabilities: A Systematic Review.

BACKGROUND: Physical activity (PA) is often used to support the development of young children (<5 years) with disabilities. The effectiveness of PA as an occupational therapy (OT) treatment approach in this population has not yet been systematically examined. AIMS: This research aimed to explore the uses and effectiveness of OT PA interventions on developmental indicators in young children with developmental disabilities. METHODS: A systematic review of peer-reviewed publications (from 2000 onward) across six electronic databases was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess study quality. Narrative synthesis (vote counting and structured reporting of effects) was employed to summarize the findings. RESULTS: Eight studies with heterogenous interventions were included. Evidence demonstrated positive trends of participation in the PA interventions on physical, cognitive, and social-emotional indicators, with significance varying. There was no association between interventions and communication indicators or negative effects related to participation in the interventions. Overall, the studies were low-quality when judged by GRADE. CONCLUSIONS: PA may be a promising avenue for OT interventions among young children with developmental disabilities. Rigorous research is needed to determine the magnitude of effect PA has on developmental indicators.

Physical Activity Among Young Children With Disabilities: A Systematic Review.

Physical activity (PA) in the early years is foundational for growth and development and associated with numerous health benefits. However, the prevalence of PA participation among the pediatric population with disabilities is less clear. This systematic review aimed to synthesize the existing literature on PA levels of young children (0-5.99 years) with disabilities. Empirical quantitative studies were collected from seven databases and reference hand searching; 21 studies were included in the review. PA levels varied widely based on disability type and measurement strategies, but overall, PA levels were low. Future research should address the underrepresentation of measurement and reporting of the PA levels of young children with disabilities.

Last glacial hydroclimate variability in the Yucatán Peninsula not just driven by ITCZ shifts.

We reconstructed hydroclimate variability in the Yucatán Peninsula (YP) based on stalagmite oxygen and carbon isotope records from a well-studied cave system located in the northeastern YP, a region strongly influenced by Caribbean climate dynamics. The new stalagmite isotopic records span the time interval between 43 and 26.6 ka BP, extending a previously published record from the same cave system covering the interval between 26.5 and 23.2 ka BP. Stalagmite stable isotope records show dominant decadal and multidecadal variability, and weaker variability on millennial timescales. These records suggest significant precipitation declines in the broader Caribbean region during Heinrich events 4 and 3 of ice-rafted discharge into the North Atlantic, in agreement with the antiphase pattern of precipitation variability across the equator suggested by previous studies. On millennial timescales, the stalagmite isotope records do not show the distinctive saw-tooth pattern of climate variability observed in Greenland during Dansgaard-Oeschger (DO) events, but a pattern similar to North Atlantic sea surface temperature (SST) variability. We propose that shifts in the mean position of the Intertropical Convergence Zone (ITCZ), per se, are not the dominant driver of last glacial hydroclimate variability in the YP on millennial timescales but instead that North Atlantic SSTs played a dominant role. Our results support a negative climate feedback mechanism whereby large low latitude precipitation deficits resulting from AMOC slowdown would lead to elevated salinity in the Caribbean and ultimately help reactivate AMOC and Caribbean precipitation. However, because of the unique drivers of future climate in the region, predicted twenty-first century YP precipitation reductions are unlikely to be modulated by this negative feedback mechanism.

Success of orthodontic treatment of linguoverted mandibular canine teeth using a direct inclined plane appliance.

This study evaluated the success rate of orthodontic treatment of linguoverted mandibular canines in dogs using a directly applied inclined plane device. Medical records were retrospectively evaluated at 11 veterinary dental specialty hospitals from 1999 to 2021. Malocclusion classes included 41.7% in class 1, 47.2% in class 2, 6.9% in class 3, and 4.2% in class 4. The severity of linguoversion was mild in 7.6% of teeth, moderate in 33.9%, and severe in 58.5%. There was complete resolution of linguoversion in 71.2% of teeth, functional resolution in 25.4%, and failure in 3.4%. The median treatment time was 42 (11-174) days. Adjuvant orthodontic treatments were performed at the same time as the inclined plane in 45.7% of teeth, including active force orthodontics, extractions of non-strategic teeth, gingivectomy, and odontoplasty. While the inclined plane was in place, 31.4% of dogs required an anesthetized appliance adjustment, and at the time of appliance removal, complications occurred in 19.4% of dogs. Of the teeth that had initial resolution, 14.4% had rebound movement that required additional treatment. This study supports the idea that an acrylic inclined plane is a good treatment option for linguoverted mandibular canines, with a 96.6% success rate within a median of 6 weeks. Yet, orthodontic retention may be necessary in these cases to avoid the need for additional therapies.

A scoping Review of Tools to Evaluate Existing Playgrounds for Inclusivity of Children with Disabilities.

Introduction: Children with disabilities may be unable engage playground spaces due to barriers exacerbating exclusion. Therefore, clarity on how to evaluate existing playgrounds for inclusivity of children with disabilities is required. Methods: A scoping review was undertaken to explore auditing tools. Results: Fourteen white and grey literature resources were identified. The term "inclusion" was operationalized differently across tools, primarily focusing on physical accessibility. Characteristics of the tools were synthesized into 13 inclusive design recommendations for playgrounds. Two tools showed promise, evaluating 12/13 recommendations. Discussion: The results of this review provide guidance on existing tools for evaluating playgrounds for inclusion for community stakeholders and researchers. Systematic Review Registration: https://osf.io/rycmj.

Non-target effects of agri-environmental schemes on solitary bees and fungi in the United Kingdom.

Agri-environmental schemes (AES) are used to enhance pollinator diversity on agricultural farms within the UK. Though the impacts of these schemes on archetypal pollinator species such as the bumblebee (Bombus) and honeybee (Apis) are well-studied, the effects on non-target bee species like solitary bees, in the same environment, are generally lacking. One goal of AES is to alter floral provision and taxonomic composition of plant communities to provide better forage for pollinators, however, this may potentially impact other ecological communities such as fungal diversity associated with plant-bee communities. Fungi are integral in these bee communities as they can impact bee species both beneficially and detrimentally. We test the hypothesis that alteration of the environment through provision of novel plant communities has non-target effects on the fungi associated with solitary bee communities. We analyse fungal diversity and ecological networks formed between fungi and solitary bees present on 15 agricultural farms in the UK using samples from brood cells. The farms were allocated to two categories, low and high management, which differ in the number of agri-environmental measures implemented. Using internal transcribed spacer metabarcoding, we identified 456 fungal taxa that interact with solitary bees. Of these, 202 (approximately 44%) could be assigned to functional groups, the majority being pathotrophic and saprotrophic species. A large proportion was Ascosphaeraceae, a family of bee-specialist fungi. We considered the connectance, nestedness, modularity, nestedness overlap and decreasing fill, linkage density and fungal generality of the farms' bee-fungi ecological networks. We found no difference in the structure of bee-fungi ecological networks between low and high management farms, suggesting floral provision by AES has no significant impact on interactions between these two taxonomic groups. However, bee emergence was lower on the low management farms compared to high management, suggesting some limited non-target effects of AES. This study characterizes the fungal community associated with solitary bees and provides evidence that floral provision through AES does not impact fungal interactions.

Physical activity among young children with disabilities: a systematic review protocol.

INTRODUCTION: Physical activity in the early years is necessary for setting the foundation for healthy growth and development in later childhood and adolescence. While most published evidence to date focuses on typically developing children, prevalence rates of physical activity among children with disabilities have been less studied. This protocol paper documents the plan of a systematic review, which aims to synthesise the evidence regarding physical activity levels among young children with disabilities. METHODS AND ANALYSIS: Searches are anticipated to commence in May 2022. Empirical quantitative studies will be considered for inclusion if they present intervention or observational data on non-therapeutic (ie, leisure time) physical activity among children <5.99 years with physical, mental, intellectual or sensory impairments. Data sources will be retrieved via electronic database searches (Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO Sports Medicine Database (SPORTDiscus), Medical Literature Analysis and Retrieval System Online (MEDLINE), Elsevier Bibliographic Database (Scopus), Psychological Abstracts (PsycINFO), Education Resources Information Centre (ERIC) and Excerpta Medica Database (EMBASE)). Additional strategies to identify relevant studies will include manual searching and citation tracking of included articles. Titles and abstracts of identified studies will be screened for inclusion, followed by full-text reviews. Three independent reviewers will conduct quality appraisal using the Downs and Black checklist. A summary of included studies will describe the study designs, participant and activity characteristics, and outcomes. ETHICS AND DISSEMINATION: This systematic review involves a secondary analysis of previously published data; therefore, this review does not require ethical approval. The proposed paper will summarise the current evidence base on physical activity levels among young children with a diagnosed disability. The findings from this systematic review will identify gaps to be explored by future research studies and inform future investigations among the paediatric disability population. PROSPERO REGISTRATION NUMBER: CRD42021266585.

Investigating the causes of reduced dissolved oxygen concentrations in Kickapoo Creek, TX.

Excessive organic matter and nutrients can depress dissolved oxygen concentration (DOC) in streams. The aim of this study was to understand the depressed DOC of Kickapoo Creek in Texas, USA, which is an impaired stream; identify the possible sources causing the depressed DOC and elevated Escherichia coli levels; and identify possible remedial measures. Monthly grab water quality data was monitored for nine stations in the watershed. For three of the nine stations, 24-h DOC was also monitored for a comparison with the minimum and average DOC criteria. Correlational, graphical, spatial, and temporal analyses were carried out for DOC concentration with other water quality variables which have the potential to depress DOC in the stream. The correlational analyses show a weak to moderate correlation for DOC with nutrient and oxygen-demanding substance concentrations present in the stream. However, there are spatial and temporal trends in DOC data that can be attributed to the nutrient influx into the stream. A pattern of increasing nutrient concentrations from upstream to downstream partially explains the decreasing dissolved oxygen (DO) concentrations observed towards the lower reaches. Visual interpretations of riparian vegetation and sediment influx also support the spatial patterns in DO concentrations. The majority of the depressed DOC occurs in the summer months when streamflow is at a minimum. The depressed DOC during summer is partially explained by the increasing daily temperatures for the summer months as revealed by the trend analysis of the daily temperature data from 1981 to 2020 using the modified Mann-Kendall test, Pettitt test, and Sen's slope.

Playground Inclusivity for Children With a Disability: Protocol for a Scoping Review.

BACKGROUND: Although playgrounds are designed to promote outdoor play, children with disabilities may be unable to engage in these spaces due to intrinsic and extrinsic factors. Previous research has examined inclusive/accessible playground design when developing new playgrounds; however, it is unclear if there is a best-practice tool for evaluating the inclusivity of existing playground structures. OBJECTIVE: A scoping review of both peer-reviewed and grey literature will be employed to explore evaluation tools for playground inclusivity, to enable the participation of children with disabilities. METHODS: The conduct of this study will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search for peer-reviewed research studies will be conducted in the following electronic databases: MEDLINE, Scopus, CINAHL, and Embase. Grey literature will be examined via a three-step process: (1) a search in the Canadian Health Research Collection Database; (2) a targeted Google search; and (3) reference list searching. Titles, abstracts, keywords, and full texts of identified studies will be independently screened for inclusion by two reviewers. A synthesis of included articles will describe the publication and auditing tool details. A summary of the findings will highlight the types of playgrounds measured, types of disability considered, measures of inclusion used, and psychometric properties. RESULTS: Database searches for peer-reviewed articles were completed in December 2021. A total of 1471 unique records were returned after the removal of 559 duplicate records. Full texts of 167 studies meeting eligibility criteria will be reviewed. The peer-reviewed research search will guide the grey literature search. The scoping review is planned for completion in 2022. CONCLUSIONS: A rigorous search of the literature will determine the availability of tools for evaluating existing playground structures for the inclusivity of children with disabilities. The results will inform recommendations on tool applications, and applicable knowledge translation activities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37312.

A review of malignant pleural mesothelioma in a large North East UK pleural centre.

OBJECTIVES: The National Mesothelioma Audit 2020 showed Northumbria to have low rates of histopathological confirmation, treatment and one-year survival rates for malignant pleural mesothelioma (MPM). We hypothesized that an internal analysis over a 10-year period provides valuable insights into presentation, diagnosis, treatment and outcomes. METHODS: A single-centre retrospective case series of all confirmed MPM patients between 1 January 2009 and 31 December 2019 was performed. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. Statistical analysis was performed using SPSS V26.0. RESULTS: A total of 247 patients had MPM. About 86% were male, mean age 75.7 years. Dyspnoea (77.4%) and chest pain (38.5%) were commonest symptoms. 64.9 and 71.4% had pleural thickening and effusion, respectively. About 86.8% had at least one attempt to obtain a tissue biopsy, but histopathological confirmation in only 108 (43.7%). About 66.3% with PS 0 and 1 (62.7% of total cohort) had at least one anti-cancer therapy. Death within 12 months was associated with disease progression within 6 months (p≤0.001). Chemotherapy (p≤0.001) and epithelioid histological subtype (p=0.01) were protective. CONCLUSIONS: This study confirms known epidemiology of MPM, demonstrates variability in practices and highlights how some NMA recommendations are not met. This provides the incentive for a regional mesothelioma multi-disciplinary meeting.

Malignant deciduoid mesothelioma: a rare variant of epithelioid mesothelioma.

We describe a case of a deciduoid mesothelioma, a rare variant of epithelioid mesothelioma, which is associated with a very poor prognosis. A review of the relevant literature is also included. The patient was a man with probable asbestos exposure and presented with classic features of pleural malignancy. Diagnosis was reached with close correlation between clinical, radiological and pathological findings.

Exploring the Effect of Perceptions on Children's Physical Activity in Varying Geographic Contexts: Using a Structural Equation Modelling Approach to Examine a Cross-Sectional Dataset.

Most Canadian children are not meeting the recommended 60 min of moderate-to-vigorous physical activity per day. Research suggests that children's perceptions of their environment have an influence on their physical activity behaviours, but there is a lack of generalizability among previous work. The purpose of this study was to assess the mediating effect of children's perceptions of barriers to physical activity on the relationship between their environments and their level of moderate-to-vigorous physical activity (measured with accelerometers). Structural equation modelling stratified by gender was used to assess the research objective in a sample of 546 participants aged 8⁻14 years old from Northwestern and Southwestern Ontario, Canada. In both models stratified by gender, perceptions of barriers did not significantly mediate the relationship between urbanicity and physical activity. Independent of all other factors, there was no significant relationship between urbanicity and physical activity in girls, but there was in boys. These results offer insight into potential processes by which perceptions impact physical activity and provide initial information to further our understanding of the behavioural aspects of physical activity through multiple levels of analysis. Researchers must continue to improve efforts for quantifying the experience of children's daily activity contexts.

Context Matters: Examining children's perceived barriers to physical activity across varying Canadian environments.

Children's perceptions of their environment have been associated with their physical activity (PA) levels, however a better understanding of the formation of perceptions within different contexts is needed. This will help to inform decision making related to physical inactivity trends in Canadian children. We examined socio-ecological factors influencing children's perceptions of barriers to PA in Ontario, Canada. Binary logistic regression models measured the relationship between perceptions of barriers and PA for 892 children in Ontario. At the intrapersonal level, girls reported the most barriers to PA. Interpersonally, children whose mother was employed reported the most barriers. At the physical environment level, children in urban and suburban neighbourhoods of large cities, and rural areas reported the most barriers, differing relative to population size. The major contribution of this paper is a new perspective of environmental influences on children's perceptions of PA, using an urbanicity spectrum, and highlighting place specific needs of Canadian children.

Developing an objective assessment of surgical performance from operating room video and surgical imagery.

An unbiased, repeatable process for assessing operating room performance is an important step toward quantifying the relationship between surgical training and performance. Hip fracture surgeries offer a promising first target in orthopedic trauma because they are common and they offer quantitative performance metrics that can be assessed from video recordings and intraoperative fluoroscopic images. Hip fracture repair surgeries were recorded using a head-mounted point-of-view camera. Intraoperative fluoroscopic images were also saved. The following performance metrics were analyzed: duration of wire navigation, number of fluoroscopic images collected, degree of intervention by the surgeon's supervisor, and the tip-apex distance (TAD). Two orthopedic traumatologists graded surgical performance in each video independently using an Objective Structured Assessment of Technical Skill (OSATS). Wire navigation duration correlated with weeks into residency and prior cases logged. TAD correlated with cases logged. There was no significant correlation between the OSATS total score and experience metrics. Total OSATS score correlated with duration and number of fluoroscopic images. Our results indicate that two metrics of hip fracture wire navigation performance, duration and TAD, significantly differentiate surgical experience. The methods presented have the potential to provide truly objective assessment of resident technical performance in the OR.

Static and dynamic validation of inertial measurement units.

Optical motion capture systems are used to assess human motion. While these systems provide a reliable analysis, they limit collection to a laboratory based setting. Devices such as Inertial Measurement Units (IMUs) have been developed as alternative tools. Commercially available IMUs are utilized for a variety of applications; however limited work has been done to determine the reliability of these devices. The objective of this study was to assess the accuracy and precision of a commercially available IMU, containing tri-axial accelerometers, gyroscopes, and magnetometers, under controlled static and dynamic conditions. The sensor output was validated against the gold standard measures of custom made mechanical testing apparatuses. The IMUs provide an accurate (within 0.6°) and precise (within 0.1°) measurement of static sensor orientation and an accurate (within 4.4° per second) and precise (within 0.2° per second) representation of angular velocity. The sensors are more accurate at lower velocities, but the percent error remains relatively constant across all angular velocities. Inclusion of IMUs as an appropriate measurement tool should be based on the application, specific demands and necessary reliability.

Value Added: the Case for Point-of-View Camera use in Orthopedic Surgical Education.

BACKGROUND: Orthopedic surgical education is evolving as educators search for new ways to enhance surgical skills training. Orthopedic educators should seek new methods and technologies to augment and add value to real-time orthopedic surgical experience. This paper describes a protocol whereby we have started to capture and evaluate specific orthopedic milestone procedures with a GoPro® point-of-view video camera and a dedicated video reviewing website as a way of supplementing the current paradigm in surgical skills training. We report our experience regarding the details and feasibility of this protocol. METHODS: Upon identification of a patient undergoing surgical fixation of a hip or ankle fracture, an orthopedic resident places a GoPro® point-of-view camera on his or her forehead. All fluoroscopic images acquired during the case are saved and later incorporated into a video on the reviewing website. Surgical videos are uploaded to a secure server and are accessible for later review and assessment via a custom-built website. An electronic survey of resident participants was performed utilizing Qualtrics software. Results are reported using descriptive statistics. RESULTS: A total of 51 surgical videos involving 23 different residents have been captured to date. This includes 20 intertrochanteric hip fracture cases and 31 ankle fracture cases. The average duration of each surgical video was 1 hour and 16 minutes (range 40 minutes to 2 hours and 19 minutes). Of 24 orthopedic resident surgeons surveyed, 88% thought capturing a video portfolio of orthopedic milestones would benefit their education. CONCLUSIONS: There is a growing demand in orthopedic surgical education to extract more value from each surgical experience. While further work in development and refinement of such assessments is necessary, we feel that intraoperative video, particularly when captured and presented in a non-threatening, user friendly manner, can add significant value to the present and future paradigm of orthopedic surgical skill training.

Assessing Wire Navigation Performance in the Operating Room.

OBJECTIVE: There are no widely accepted, objective, and reliable tools for measuring surgical skill in the operating room (OR). Ubiquitous video and imaging technology provide opportunities to develop metrics that meet this need. Hip fracture surgery is a promising area in which to develop these measures because hip fractures are common, the surgery is used as a milestone for residents, and it demands technical skill. The study objective is to develop meaningful, objective measures of wire navigation performance in the OR. DESIGN: Resident surgeons wore a head-mounted video camera while performing surgical open reduction and internal fixation using a dynamic hip screw. Data collected from video included: duration of wire navigation, number of fluoroscopic images, and the degree of intervention by the surgeon׳s supervisor. To determine reliability of these measurements, 4 independent raters performed them for 2 cases. Raters independently measured the tip-apex distance (TAD), which reflects the accuracy of the surgical placement of the wire, on all the 7 cases. SETTING: University of Iowa Hospitals and Clinics in Iowa City, IA-a public tertiary academic center. PARTICIPANTS: In total 7 surgeries were performed by 7 different orthopedic residents. All 10 raters were biomedical engineering graduate students. RESULTS: The standard deviations for anteroposterior, lateral, and combined TAD measurements of the 10 raters were 2.7, 1.9, and 3.7mm, respectively, and interrater reliability produced a Cronbach α of 0.97. The interrater reliability analysis for all 9 video-based measures produced a Cronbach α of 0.99. CONCLUSIONS: Several video-based metrics were consistent across the 4 video reviewers and are likely to be useful for performance assessment. The TAD measurement was less reliable than previous reports have suggested, but remains a valuable metric of performance. Nonexperts can reliably measure these values and they offer an objective assessment of OR performance.