Impact and Implementation of an Early Years Fundamental Motor Skills Intervention for Children 4-5 Years.

Fundamental motor skills (FMS) are the cornerstone of a child's motor development, but concerns remain on the current level of FMS competencies, and intervention is required. This evaluation investigated if a targeted Early Years FMS intervention, delivered by a specialist physical education (PE) provider, improved the FMS of 4-5-year-old children across multiple sites. METHODS: The Early Years FMS intervention ran for 18 weeks, 1 h/week, using a standardised programme of activities to develop FMS competencies across 219 children from 15 schools in the Midlands, UK. An adapted assessment was employed as a measure of FMS, assessing locomotor, object control, and stability skills at weeks 1, 9, and 18. The FMS were each rated as green = competent, amber = working towards, or red = not meeting the standards of the skill. A description of key programme implementation characteristics was described. FINDINGS: Statistically significant increases in FMS competencies were achieved for 80% of participants at 18 weeks. Key implementation characteristics for the intervention included consistent staffing, a standardised programme, and a variety of pedagogical approaches delivered by specialist PE staff. CONCLUSION: This evaluation provided important insights into the effectiveness and implementation of the Early Years FMS intervention to improve FMS competencies in children aged 4-5 years.

The association of lower urinary tract symptoms with schizophrenia and its treatments: A narrative review.

BACKGROUND: A higher incidence of lower urinary tract symptoms (LUTS) in people with schizophrenia compared to the general population is often suggested. However, it is not clear whether this is a genuine association, and whether it is a direct result of schizophrenia itself, or a side-effect of certain antipsychotics. METHODS: We undertook a narrative review evaluating how the published literature reports the relationship between LUTS and schizophrenia and its treatments. We searched Embase, Ovid Emcare, and Ovid MEDLINE(R) ALL to August 2022, limited to the English language. We selected the following search terms: schizophrenia, schizophrenic, LUTS, overactive bladder, urinary urgency, urinary incontinence, overactive bladder, enuresis, nocturnal enuresis, and voiding dysregulation. We identified seven domains for assessment in advance of commencing the review. These were the categorization, description, and treatment status of schizophrenia; evaluation of LUTS; categorization of LUTS confounders; recapturing of the disease states of both schizophrenia and LUTS after therapies; assessment of the association between LUTS and schizophrenia and/or antipsychotics. RESULTS: The association between LUTS and schizophrenia was poorly described. The evidence was low quality and focused predominantly on urinary incontinence as an antipsychotic side effect, neglecting other LUTS. The status of schizophrenia was often incompletely characterized, and no papers made use of a bladder diary or LUTS-specific questionnaires to assess symptoms. No papers collected information about LUTS in patients not on antipsychotics, nor did any thoroughly evaluate the influence of confounding variables. Despite the tendency of symptoms and severity of both conditions to fluctuate over time, no studies fully assessed the status of both schizophrenia and LUTS at baseline, therapy initiation, and follow-up. CONCLUSIONS: It is not possible to state whether there is an association between LUTS and schizophrenia or its treatments. This review highlights the need to improve research and clinical management of the urinary tract in schizophrenia, with meticulously designed longitudinal studies.

Handedness, Bilateral, and Interdigit Strength Asymmetries in Male Climbers.

PURPOSE: To determine whether there are bilateral and interdigit differences in the maximal force production of experienced climbers and whether these differences are mediated by ability level or preferred style of climbing. METHODS: Thirty-six male climbers (age 30 [9.4] y) took part in a single-session trial to test their maximal force production on both hands. The tests included a one-arm maximal isometric finger flexor strength test (MIFS) and a one-arm individual MIFS. Bilateral differences were analyzed by strongest hand (defined as the hand that produced the highest MIFS value) and dominance (defined as the writing hand). RESULTS: A pairwise t test found that MIFS was significantly greater for the strongest hand (mean difference = 4.1%, 95% CI, -0.052 to 0.029, P < .001), with handedness explaining 89% of the variation. A 2-way mixed-model analysis of variance determined that there were no interactions between preferred style (bouldering or sport climbing) and MIFS or between ability level (advanced or elite) and MIFS. CONCLUSIONS: Climbers have significant finger flexor strength bilateral asymmetries between their strongest and weakest hand. Moreover, when dominance is controlled, this difference in strength is present, with the dominant hand producing more force. Neither preferred style of climbing nor the ability level of the climbers could explain these asymmetries. As such, practitioners should consider regularly monitoring unilateral strength, aiming to minimize the likelihood of large bilateral asymmetry occurring.

Paediatric family activation rapid response (FARR) in tertiary healthcare organisations: Protocol for an online, multi-lingual, application (app) intervention development study.

INTRODUCTION: At least 85% of unplanned admissions to critical care wards for children and young people (CYP) are associated with clinical deterioration. CYP and their families play an integral role in the recognition of deterioration. The Paediatric Critical Care Outreach Team (PCCOT) supports the reduction of avoidable harm through earlier recognition and treatment of the deteriorating child, acting as a welcome conduit between the multiprofessional teams, helping ensure that CYP gets the right care, at the right time and in the right place. This positions PCCOT well to respond to families who call for help as part of family activation. AIM: This protocol details the methods and process of developing a family activation rapid response online application. METHODS: This is a single-centre, sequential, multiple methods study design. Firstly, a systematic review of the international literature on rapid response interventions in paediatric family activation was conducted. Findings from the review aimed to inform the content for next stages; interviews/ focus groups and experience-based co-design (EBCD) workshops. PARTICIPANTS: parents / caregivers whose children have been discharged or admitted to an acute care hospital and healthcare professionals who care for paediatric patients (CYP). During interviews and workshops participants' opinion, views and input will be sort on designing a family activation rapid response online-app, detailing content, aesthetics, broad functionality and multi-lingual aspects. Further areas of discussions include; who will use the app, access, appropriate language and terminology for use. A suitable app development company will be identified and will be part of the stakeholders present at workshops. Data obtained will be used to develop a multi-lingual paediatric family activation rapid response web based application prototype. ETHICS AND DISSEMINATION: Full ethical approval was received from the Wales Research Ethics Committee 2. Cardiff; REC reference: 22/WA/0174. The findings will be made available to all stakeholders.

Responsiveness variability during anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks.

Anaesthesia combined with functional neuroimaging provides a powerful approach for understanding the brain mechanisms of consciousness. Although propofol is used ubiquitously in clinical interventions that reversibly suppress consciousness, it shows large inter-individual variability, and the brain bases of this variability remain poorly understood. We asked whether three networks key to conscious cognition-the dorsal attention (DAN), executive control (ECN), and default mode (DMN)-underlie responsiveness variability under anaesthesia. Healthy participants (N = 17) were moderately anaesthetized during narrative understanding and resting-state conditions inside the Magnetic Resonance Imaging scanner. A target detection task measured behavioural responsiveness. An independent behavioural study (N = 25) qualified the attention demands of narrative understanding. Then, 30% of participants were unaffected in their response times, thus thwarting a key aim of anaesthesia-the suppression of behavioural responsiveness. Individuals with stronger functional connectivity within the DAN and ECN, between them, and to the DMN, and with larger grey matter volume in frontal regions were more resilient to anaesthesia. For the first time, we show that responsiveness variability during propofol anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks, which can be predicted prior to sedation. Results highlight novel markers for improving awareness monitoring during clinical anaesthesia.

Paediatric family activated rapid response interventions; qualitative systematic review.

BACKGROUND: Failure to recognise deterioration early which results in patient death, is considered failure to rescue and it is identified as one of the leading causes of harm to patients. It is recognised that patients and their families can often recognise changes within the child's condition before healthcare professionals. To mitigate the risk of failure to rescue and promote early intervention, family-activated rapid response systems are becoming widely acknowledged and accepted as part of family integrated care. OBJECTIVE: To identify current family-activated rapid response interventions in hospitalised paediatric patients and understand mechanisms by which family activation works. METHODS: A narrative systematic review of published studies was conducted. Seven online databases; AMED, CINHAL, EMBASE, EMCARE, HMIC, JBI, and Medline were searched for potentially relevant papers. The critical appraisal skills programme tool was used to assess methodological rigor and validity of included studies. RESULTS: Six studies met the predefined inclusion criteria. Five telephone family activation interventions were identified; Call for Help, medical emergency-teams, Condition HELP, rapid response teams, and family initiated rapid response. Principles underpinning all interventions were founded on a principal of granting families access to a process to escalate concerns to hospital emergency teams. Identified interventions outcomes and mechanisms include; patient safety, empowerment of families, partnership working/ family centred care, effective communication and better patient outcomes. Interventions lacked multi-lingual options. CONCLUSION: Family activation rapid response system are fundamental to family integrated care and enhancing patient safety. Underlying principles and concepts in delivering interventions are transferable across global healthcare system.

The civil rights of disabled children in physiotherapy practices.

PURPOSE: This study aimed to explore the experiences of civil rights of disabled children receiving physiotherapy in New Zealand. As yet there is limited attention given to this topic in rehabilitation literature. METHODS: We conducted a qualitative study that drew on the fields of childhood studies and disability studies to address the study aim. Seven disabled children who used local physiotherapy services (aged between four and 14 years) were interviewed using child-centered methods. In addition, their parents were interviewed individually, and eight rehabilitation professionals and disability advocates took part in a focus group discussion. Interpretive thematic analysis was used to analyze findings. FINDINGS: The participating disabled children all appreciated being informed about physiotherapy, but had individual preferences regarding involvement in decision making. They described positive and negative influences on their experiences, but indicated they may not have been asked by adults about these. Parents, professionals and advocates described that attempting to promote a positive experience for children is constrained by understandings regarding the purposes and practices of physiotherapy. CONCLUSIONS: Our findings suggest it is important to get an understanding of individual children's views and preferences regarding physiotherapy in order to promote opportunities for choice, control and satisfaction. In this way physiotherapists can ensure disabled children's civil rights are realized in practice.

Reducing failure to rescue rates in a paediatric in-patient setting: A 9-year quality improvement study.

BACKGROUND: Annually in England, over 1.5 million children and young people (CYP) are admitted to hospital. However, a proportion of these CYP will experience failure to rescue (FtR), a failure to recognize, respond and escalate clinical deterioration, which can result in significant harm or death. AIM: To identify and quantify FtR episodes from emergency events at a 110-bedded tertiary children's hospital located within a University Teaching Hospital and evaluate the impact of targeted interventions on reducing FtR. METHODS: A quality improvement approach was adopted. From 170 446 patients admitted between 2011 and 2019, all emergency event calls were systematically reviewed to identify FtR episodes. Root-cause analysis was performed to identify practice deficiencies. The Plan-Do-Study-Act fundamentals were used. RESULTS: A total of 520 emergency events were reviewed over the 9-year period. One hundred and thirty-two (n = 132; 25%) were cardiac arrest events, with the majority occurring within the PCCU setting. Three hundred and twelve (60%) of the events were in children who had been inpatient for more than 48 hours. FtR trend declined over the study period from 23.6% in 2011 when the project commenced to 2.5% or less over the following 8 years. CONCLUSIONS: Identifying rates of FtR events from routinely collected emergency events data can be used as a patient safety measure to identify emergency concerns. This enables dynamic problem solving through delivery of strategic and targeted interventions. The proposed interventions outlined in this quality improvement study have application to critical care nursing as mechanisms for reducing unplanned admissions to paediatric critical care unit (PCCU), patient mortality, and PCCU and non-PCCU cardiac arrests. RELEVANCE TO CLINICAL PRACTICE: This study emphasises the importance in understanding the antecedence of emergency events for paediatric inpatient populations. This intelligence can be used to direct targeted interventions to significantly reduce failure to rescue rates.

Promoting students' safety and wellbeing: ethical practice in schools.

Although 'child safety' is now a national policy priority in Australia, there is little research exploring the practices in schools that contribute to children and young people's felt sense of safety and wellbeing. Drawing on a mixed-method Australian Research Council (ARC) Discovery project, this article presents findings from interviews with school staff (N = 10), leaders (N = 5) and nine focus groups with students (N = 58), in primary and secondary schools in three Australian states (New South Wales, Victoria and South Australia). We employ relational ethics, recognition theory and the theory of practice architectures to explore practices at school that support student wellbeing and safety. The findings contribute significantly to understanding the 'bundled' nature of current practices and the conditions that enable and constrain these. Close attention to these findings is critical as schools seek to operationalise the National Child Safe Principles and refine ongoing safeguarding procedures. The findings have informed the development of an online survey that is currently testing, on a much larger scale, which elements of ethical practice are most positively associated with students' safety, wellbeing and recognition at school.

Safety and effectiveness of do-it-yourself artificial pancreas system compared with continuous subcutaneous insulin infusions in combination with free style libre in people with type 1 diabetes.

AIMS: The use of do-it-yourself artificial pancreas systems (DIYAPS) among people with type 1 diabetes is increasing. At present, it is unclear how DIYAPS compares with other technologies such as FreeStyle Libre (FSL) and continuous subcutaneous insulin infusion (CSII). The aim of this analysis is to compare safety, effectiveness and quality-of-life outcomes of DIYAPS use with the addition of FSL to CSII. METHOD: Data from two large UK hospitals were extracted from the Association of British Clinical Diabetologists (ABCD) DIYAPS and FSL audits. Outcomes included HbA1c , glucose TBR (time-below-range), TIR (time-in-range), Diabetes Distress Score (DDS), and Gold hypoglycaemia score. Any adverse events were noted. Changes at follow-up were assessed using paired t-tests and ANOVA in Stata; TIR/TBR at follow-up assessed using unpaired t-tests; chi-square tests assessed the change in frequency of health utilisation (e.g. hospital admissions). RESULTS: DIYAPS (n = 35) and FSL+CSII (n = 149) users, with median follow-up duration of 1.4 (IQR 0.8-2.1) and 1.3 (IQR 0.7-1.8) years, respectively, were included. HbA1c with DIYAPS use changed by -10 mmol/mol [0.9%] (p < 0.001, 95% CI 5, 14 [0.5, 1.3%]) significantly lower (p < 0.001) than in the FSL+CSII group -3 mmol/mol [0.25%] (p < 0.001, 95% CI 1, 4 [0.1, 0.4%]). TIR was higher and TBR was lower in the DIYAPS group. Adverse events were rare in both groups and no significant differences were observed in the frequency of healthcare utilisation. CONCLUSION: DIYAPS use was associated with a lower HbA1c levels, higher TIR and lower TBR compared with FSL+CSII. There was no significant increase in adverse events, although this should be interpreted cautiously given the low numbers of users. Full results from the ABCD DIYAPS audit are awaited.

A Longitudinal Study of Mental Wellbeing in Students in Aotearoa New Zealand Who Transitioned Into PhD Study.

Journal editorials, career features, and the popular press commonly talk of a graduate student mental health crisis. To date, studies on graduate student mental health have employed cross-sectional designs, limiting any causal conclusions regarding the relationship between entry into graduate study and mental health. Here, we draw on data from a longitudinal study of undergraduate students in Aotearoa New Zealand, allowing us to compare participants who did, and did not, transition into PhD study following the completion of their undergraduate degree. Using multilevel Bayesian regression, we identified a difference in mental wellbeing between those who entered PhD study and those who did not. This difference, however, was largely due to those not entering PhD study displaying an increase in mental wellbeing. Participants that entered PhD study displayed a small decrease in mental wellbeing, with the posterior distribution of the simple effect heavily overlapping zero. This latter finding was orders of magnitude smaller than one might expect based on previous cross-sectional research and provides an important message; that a marked drop in mental health is not an inevitable consequence of entering graduate study.

Predicting Infection Risk in Multiple Sclerosis Patients Treated with Ocrelizumab: A Retrospective Cohort Study.

BACKGROUND: Ocrelizumab safety outcomes have been well evaluated in clinical trials and open-label extension (OLE) studies. However, risk factors for infection in patients with multiple sclerosis (MS) receiving ocrelizumab have not been extensively studied in the real-world setting. OBJECTIVE: The aim of this study was to examine factors determining risk of self-reported infections and antimicrobial use in patients receiving ocrelizumab for MS. METHODS: A retrospective, observational cohort study was conducted in patients receiving ocrelizumab at the Royal Melbourne Hospital. Infection type and number were reported by patients, and the associations of potential clinical and laboratory risk factors with self-reported infection and antimicrobial use were estimated using univariate and multivariable logistic regression models. RESULTS: A total of 185 patients were included in the study; a total of 176 infections were reported in 89 patients (46.1%), and antimicrobial use was identified in 47 patients (25.3%). In univariate analyses, a higher serum IgA was associated with reduced odds of infection (OR 0.44, 95% CI 0.25-0.76). In multivariable analyses, older age (OR 0.94, 95% CI 0.88-0.99), higher serum IgA (OR 0.37, 95% CI 0.17-0.80) and higher serum IgG (OR 0.81, 95% CI 0.67-0.99) were associated with reduced odds of infection. Older age (OR 0.85, 95% CI 0.75-0.96) and higher serum IgA (OR 0.23, 95% CI 0.07-0.79) were associated with reduced odds of antimicrobial use, whilst longer MS disease duration (OR 1.22, 95% CI 1.06-1.41) and higher Expanded Disability Status Scale (EDSS) score (OR 1.99, 95% CI 1.02-3.86) were associated with increased odds of antimicrobial use. CONCLUSIONS: Higher serum IgA and IgG and older age were associated with reduced odds of infection. Our findings highlight that infection risk is not uniform in patients with MS receiving ocrelizumab and substantiate the need to monitor immunoglobulin levels pre-treatment and whilst on therapy.

Performance Assessment for Rock Climbers: The International Rock Climbing Research Association Sport-Specific Test Battery.

PURPOSE: To examine the validity and reliability of a battery of 10 measures designed to assess the key physiological parameters for successful rock climbing performance. METHODS: In phase 1 of the research, an expert panel, using the Delphi method, established a 10-item test battery based on the key determinants of climbing performance. In phase 2, the tests were assessed for validity and reliability to examine their suitability as sport-specific measures of rock climbing performance. A total of 132 rock climbers, from 7 countries, volunteered to take part in the study. Each climber visited their nearest laboratory on 3 separate occasions in order to enable the required tests and retests to be completed. A minimum of 7 days was allowed between visits. RESULTS: The 10 tests established for phase 2 were designed as sport-specific measures of flexibility, strength, power, and endurance. Results indicated that, while reliable, the flexibility and strength tests were only partially successful in differentiating across climber abilities. The power and endurance tests, however, performed well with regard to validity and reliability, with the finger hang and powerslap tests being most strongly correlated with performance ability (P < .0005 to P < .002). CONCLUSION: The authors' data suggest that climbing may require a threshold level of flexibility and strength for successful performance, beyond which further improvements may not be required. In contrast, the finger hang and powerslap tests were not only reliable measures but also differentiated between climber abilities from lower grade to elite levels.

An All-Out Test to Determine Finger Flexor Critical Force in Rock Climbers.

PURPOSE: The fatigue resistance of the finger flexors is known to be a key determinant of climbing performance. This study set out to establish the association between the single all-out assessment of finger flexor critical force (ff-CF) and the impulse above CF (W') on climbing performance (self-reported sport and boulder climbing ability). METHODS: A total of 129 subjects completed an assessment of dominant arm ff-CF, comprised of a series of rhythmic isometric maximum voluntary contractions (CF defined as mean end-test force [in kilograms]; W' impulse above CF [in kilogram second]). RESULTS: The ff-CF protocol resulted in the same force decay to a plateau seen in previous isometric critical torque and critical force tests. Linear regression analysis, adjusting for sex, revealed that CF percentage of body mass explained 61% of sport and 26% of bouldering performance and W' per kilogram body mass explained 7% sport and 34% bouldering performance. A combined model of CF as a percentage of body mass and W' per kilogram body mass, after adjustment for sex differences, was able to explain 66% of sport climbing and 44% of bouldering performance. CONCLUSIONS: The results illustrate the relevance of the CF threshold in describing the fatigue resistance of the finger flexors of rock climbers. Given ff-CF ability to describe a considerable proportion of variance in sport climbing and bouldering ability, the authors expect it to become a common test used by coaches for understanding exercise tolerance and for determining optimal training prescription.

Establishing a clinical psychology team within the orthognathic service: A triad model of orthodontic, maxillofacial and psychological care.

The importance of psychological support for orthognathic patients has taken an increasing precedence over recent years and is embedded in orthognathic commissioning guidelines. Furthermore, attention towards mental health-related conditions and their management is of prime importance and continues to be a key area of focus within healthcare settings. With this in mind, this paper aims to outline our experience of establishing a need for and subsequently securing funding to establish a clinical psychology service within an existing orthognathic service in the NHS. The information outlined may be of benefit to orthognathic teams seeking to secure such psychological support within their respective units.

Anthropometry and performance characteristics of recreational advanced to elite female rock climbers.

Despite climbing's popularity and an increasing number of female participants, there are limited anthropometric and performance data for this population. This study compares the characteristics of 55 experienced female climbers, divided into three categories (lower [ADV-L] and higher advanced [ADV-H] and elite [ELT]) based on self-reported ability. Data on climbing experience, body dimensions, body composition, flexibility, lower and upper-body power and finger strength were assessed. ELT climbers differed significantly from the ADV groups in age (Mean Difference [MD] = 8.8-9.8 yrs; despite smaller differences in years climbing MD = 1.6-2.4 yrs), greater climbing and hours training per week (MD = 3.0-3.7 h & MD = 0.9-1.6 h, respectively), and greater upper-body power (MD = 12.9-16.6 cm) and finger strength (MD = 51.6-65.4 N). Linear regression analysis showed finger strength and upper body power to be associated with ability, particularly when adjusting for descriptive and anthropometric variables (finger strength R2 = 53% and 45%; upper-body power R2 = 60% and 39% for boulder and sport, respectively). The findings support the importance of finger strength and upper-body power; changes in female anthropometric data over the last decade provide insight into the changing nature of the sport.

Fast and safe: Optimising multiple sclerosis infusions during COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic challenges multiple sclerosis services to be innovative in delivering infusible therapies. To reduce time in clinical settings, and potential staff or space losses, we implemented rapid infusion protocols for selected patients. OBJECTIVE: To analyse the rate of infusion related reactions and patient experience of rapid infusions of natalizumab and ocrelizumab. To document time reduction patients spent in clinical settings during the COVID-19 pandemic. METHODS: Patients with prior exposure to at least three natalizumab or two 300mg ocrelizumab infusions were approved for rapid protocols. A retrospective audit and survey were completed. RESULTS: We analysed 269 rapid natalizumab infusions and 100 rapid ocrelizumab infusions. Infusion related reactions during the natalizumab or ocrelizumab infusions occurred in two patients (1.52%) and eight patients (8%), respectively. All infusion related reactions were mild to moderate and did not require infusion discontinuation. No infusion reactions occurred during the post-infusion observation. Patient experience was positive. CONCLUSION: Frequency or severity of infusion related reactions in rapid infusions were no different compared to published data. In the setting of COVID-19, pandemic rapid infusion protocols could potentially save hospital resources and limit patient exposure to a high-risk clinical setting while still maintaining ongoing treatment of multiple sclerosis.

Evaluating the perspective of patients with MS and related conditions on their DMT in relation to the COVID-19 pandemic in one MS centre in Australia.

OBJECTIVE: Patients with Multiple Sclerosis (MS) and on disease modifying therapies (DMTs) that can be immunosuppressive or immunomodulatory form a special group where risk of continuation of DMT needs to be taken into account with risk of contracting Covid-19. This concept can pose a degree of anxiety for patients as well as neurologists. We aimed to evaluate patient perspectives regarding the use of Natalizumab and anti-CD20 therapies (Rituximab and Ocrelizumab) in the context of the COVID-19 pandemic. METHODS: cross-sectional study conducted via voluntary survey filled in by patients with MS and related disorders receiving their infusional treatment in one MS centre in Australia, exploring their concerns regarding their therapy, their therapy and COVID-19, precautions undertaken in response to the pandemic, and factors impacting their decision-making. RESULTS: 170 patients completed the survey. Of patients on Natalizumab, the majority had either no or mild concern regarding their DMT and COVID-19, and of patients on B-cell depleting therapies, again, the majority had no or mild concern, though a slightly higher proportion had a moderate level of concern. Asked to delineate their concerns, an increased risk of contracting COVID-19 was more commonly conveyed than MS-specific factors or poor outcomes pertaining to COVID-19 if contracted, by patients in both groups. Conversely, being invited to specifically consider the possibility of contracting COVID-19 or experience a relapse of MS, almost half of the cohort rated both of equal of concern. More than half of the cohort were self-isolating more stringently than general government advice and government-related resources followed by information provided by patient's neurologist where the commonest means of information to guide decision making. CONCLUSIONS: Whilst a large proportion of patients had some concern regarding the impact of their DMT on COVID-19, whether on their risk of contracting COVID-19 or a theoretical risk for more severe disease, the overall level of concern in most cases was at most mild. Patients on B-cell depleting therapies were more inclined to express a higher level of concern. A similar concern was ascribed to a risk of a relapse or worsening MS symptoms compared to the risk of contracting COVID-19. Such attitudes may underscore a willingness of patients to continue their DMT where benefits outweigh risks during future phases of the COVID-19 pandemic.

Memory During the Presumed Vegetative State: Implications for Patient Quality of Life.

A growing number of studies show that a significant proportion of patients, who meet the clinical criteria for the diagnosis of the vegetative state (VS), demonstrate evidence of covert awareness through successful performance of neuroimaging tasks. Despite these important advances, the day-to-day life experiences of any such patient remain unknown. This presents a major challenge for optimizing the patient's standard of care and quality of life (QoL). We describe a patient who, following emergence from a state of complete behavioral unresponsiveness and a clinical diagnosis of VS, reported rich memories of his experience during this time. This case demonstrates the potential for a sophisticated mental life enabled by preserved memory in a proportion of patients who, similarly, are thought to be unconscious. Therefore, it presents an important opportunity to examine the implications for patient QoL and standard of care, both during the period of presumed unconsciousness and after recovery.

The Visual Search Strategies Underpinning Effective Observational Analysis in the Coaching of Climbing Movement.

Despite the importance of effective observational analysis in coaching the technical aspects of climbing performance, limited research informs this aspect of climbing coach education. Thus, the purpose of the present research was to explore the feasibility and the utility of a novel methodology, combining eye tracking technology and cued retrospective think-aloud (RTA), to capture the cognitive-perceptual mechanisms that underpin the visual search behaviors of climbing coaches. An analysis of gaze data revealed that expert climbing coaches demonstrate fewer fixations of greater duration and fixate on distinctly different areas of the visual display than their novice counterparts. Cued RTA further demonstrated differences in the cognitive-perceptual mechanisms underpinning these visual search strategies, with expert coaches being more cognizant of their visual search strategy. To expand, the gaze behavior of expert climbing coaches was underpinned by hierarchical and complex knowledge structures relating to the principles of climbing movement. This enabled the expert coaches to actively focus on the most relevant aspects of a climber's performance for analysis. The findings demonstrate the utility of combining eye tracking and cued RTA interviewing as a new, efficient methodology of capturing the cognitive-perceptual processes of climbing coaches to inform coaching education/strategies.