Design, Transport/Molecular Scale Electronics, Electric Properties, and a Conventional Quantum Study of a New Potential Molecular Switch for Nanoelectronic Devices.

In this study, we examined the influence of an external electric field applied in two directions: horizontal (X-axis) and vertical (Y-axis) on the electronic and vibrational properties of a field-effect molecular switch, denoted as M. We employed density functional theory and quantum theory of atoms in molecules for this analysis. The current-voltage (I-V) characteristic curve of molecular switch system M was computed by applying the Landauer formula. The results showed that the switching mechanism depends on the direction of the electric field. When the electric field is applied along the X-axis and its intensity is around 0.01 au, OFF/ON switching mechanisms occur. By utilizing electronic localization functions and localized-orbital locator topological analysis, we observed significant intramolecular electronic charge transfer "back and forth" in Au-M-Au systems when compared to the isolated system. The noncovalent interaction revealed that the Au-M-Au complex is also stabilized by electrostatic interactions. However, if the electric field is applied along the Y-axis, a switching mechanism (OFF/ON) occurs when the electric field intensity reaches 0.008 au. Additionally, the local electronic phenomenological coefficients (Lelec) of this field-effect molecular switch were determined by using the Onsager phenomenological approach. It can also be predicted that the molecular electrical conductance (G) increases as Lelec increases. Finally, the electronic and vibrational properties of the proposed models M and Au-M-Au exhibit a powerful switching mechanism that may potentially be employed in a new generation of electronic devices.

Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review.

PURPOSE: To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. METHODS: Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evidence was established through the GRADE approach. RESULTS: The methodological quality of the 24 eligible reviews (stroke, n = 16; spinal cord injury (SCI), n = 5; multiple sclerosis (MS); n = 2; mixed population, n = 1) ranged from critically low to high. Stroke reviews concluded that FES improved walking speed through an orthotic (immediate) effect and had a therapeutic benefit (i.e., over time) compared to usual care (low certainty evidence). There was low-to-moderate certainty evidence that FES was no better or worse than an Ankle Foot Orthosis regarding walking speed post 6 months. MS reviews concluded that FES had an orthotic but no therapeutic effect on walking. SCI reviews concluded that FES with or without treadmill training improved speed but combined with an orthosis was no better than orthosis alone. FES may improve quality of life and reduce falls in MS and stroke populations. CONCLUSION: FES has orthotic and therapeutic benefits. Certainty of evidence was low-to-moderate, mostly due to high risk of bias, low sample sizes, and wide variation in outcome measures. Future trials must be of higher quality, use agreed outcome measures, including measures other than walking speed, and examine the effects of FES for adults with cerebral palsy, traumatic and acquired brain injury, and Parkinson's disease.

Comprehensive geriatric assessment delivered by advanced nursing practitioners within primary care setting: a mixed-methods pilot feasibility randomised controlled trial.

BACKGROUND: Comprehensive Geriatric Assessment (CGA)is a widely accepted intervention for frailty and can be cost-effective within a primary care setting. OBJECTIVE: To explore the feasibility of identifying older adults with frailty and assess the subsequent implementation of a tailored CGA with care and support plan by Advanced Nursing Practitioners (ANPs). METHODS: A mixed-method parallel randomised controlled trial was conducted. Participants were recruited from two General Practice (GP) centres between January and June 2019. Older adults with confirmed frailty, as assessed by practice nurses, were randomised, using a web service, to the intervention or treatment-as-usual (TAU) groups for six months with an interim and a final review. Data were collected on feasibility, health service usage, function, quality of life, loneliness, and participants' experience and perception of the intervention. Non-parametric tests were used to analyse within and between-group differences. P-values were adjusted to account for type I error. Thematic analysis of qualitative data was conducted. RESULTS: One hundred sixty four older adults were invited to participate, of which 44.5% (n = 72) were randomised to either the TAU (n = 37) or intervention (n = 35) groups. All participants in the intervention group were given the baseline, interim and final reviews. Eight participants in each group were lost to post-intervention outcome assessment. The health service use (i.e. hospital admissions, GP/emergency calls and GP/Accident Emergency attendance) was slightly higher in the TAU group; however, none of the outcome data showed statistical significance between-group differences. The TAU group showed a deterioration in the total functional independence and its motor and cognition components post-intervention (p < .05), though the role limitation due to physical function and pain outcomes improved (p < .05). The qualitative findings indicate that participants appreciated the consistency of care provided by ANPs, experienced positive therapeutic relationship and were connected to wider services. DISCUSSION: Frailty identification and intervention delivery in the community by ANPs were feasible. The study shows that older adults with frailty living in the community might benefit from intervention delivered by ANPs. It is suggested to examine the cost-effectiveness of the intervention in sufficiently powered future research. TRIAL REGISTRATIONS: The protocol is available at clinicaltirals.gov, ID: NCT03394534; 09/01/2018.

The effects of a custom foot orthosis on dynamic plantar pressure in patients with chronic plantar fasciitis: A randomized controlled trial.

BACKGROUND: Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia supports the longitudinal arch and absorbs ground reaction forces during the static and dynamic phase(s) of weight-bearing. The purpose of this randomized controlled trial study was to determine the effects of CAD/CAM foot orthoses that were designed based on the dynamic plantar pressure in patients with plantar fasciitis. METHODS: This study was performed on 34 patients with plantar fasciitis. Outcomes were compared based on plantar fascia thickness; peak pressure, mean pressure, and maximum force; and pain, activity of daily living, quality of life, and sports activity that were evaluated by ultrasound, plantar pressure platform, and the Foot and Ankle Outcome Score, respectively. The patients were randomly assigned into two groups: the experimental group (CAD/CAM orthoses and night splint) and the control group (night splint only). All data were recorded again after 4 weeks. RESULTS: Pain ( P = 0.002) and plantar fascia thickness ( P = 0.001) decreased significantly after 1 month of intervention. Activity of daily living ( P = 0.044) and quality of life ( P = 0.001) showed a significant increase. There was a trend in increasing peak pressure in all masking regions in both groups. The maximum force remarkably reduced in the experimental group in all regions. CONCLUSIONS: The results demonstrated that CAD/CAM foot orthoses designed based on dynamic plantar pressure with night splint can reduce the plantar fascia thickness and pain associated with plantar fasciitis and increase the activity of daily living, quality of life, and sports activity.

The effect of hydrolyzed sesame meal protein on the quality and shelf life of hamburgers during refrigerated storage.

In this study, to improve the quality and shelf life of hamburgers, sesame meal protein hydrolysates (SPH) were produced using two enzymes of alcalase and flavourzyme and then four hamburger treatments: T1: control (10% soybean), T2: 1% SPH + soybean 9%, T3: 2% SPH + soybean 8%, and T4: 3% SPH + soybean 7% were prepared. Physicochemical properties were analyzed at the beginning of the storage period; microbial and chemical quality was evaluated at intervals of 0, 4, 8, 12, and 16 days. The results of SPH showed that alcalase enzyme can produce a SPH with a higher antioxidant properties (DPPH, FRAP, and beta-carotene-linoleic acid) (P < 0.05); therefore, this SPH was used for hamburger properties. According to the results, with the addition of SPH, moisture, fat, texture firmness decreased, protein, and brightness increased (P < 0.05), and all treatments had the allowable range. SPH replacement with soybean slowed down the increasing trend of oxidation and microbial spoilage (P < 0.05). In general, better results were observed in T3 and T4, which had a permissible range chemical and microbial index until the end of the storage period, as well as these treatments inhibited the growth of Staphylococcus aureus and Escherichia coli. Only T3 was approved by the evaluators.

The experience of pre-hospital emergency personnel in breaking death news: a phenomenological study.

BACKGROUND: Today, breaking the death of patients to their families has become one of the challenges for medical staff. Considering the lack of study in the pre-hospital emergency, the present study aimed to explore the experience of pre-hospital emergency personnel regarding the breaking death news to families. METHOD: In this qualitative study with a descriptive phenomenological method, data were collected by purposeful sampling method through in-depth interviews with thirteen pre-hospital emergency personnel in Kermanshah and Kurdistan provinces. After recording and writing the interviews, the data were managed by MAQUDA-10 software and analyzed using the Collaizi approach. RESULTS: Of 13 participants, five from Kermanshah, eight from Kurdistan, and 12 (92%) were married. The mean age and work experience were 34.38 and 10.38 years, respectively. Five main extracted themes were 1) perceived stress, 2) challenge factors of breaking death news, 3) unnecessary actions, 4) death breaking precautions, and 5) BDN requirements. They were covered fifteen sub-themes. CONCLUSION: In this study, emergency medical employees were always faced with stress and challenges to announce the patient's death to families, including the stress of violence against employees. Hereof, personnel had to take unnecessary care actions such as slow resuscitation to transfer the patient to the hospital.

Evaluation of stability and antibacterial properties of extracted chlorophyll from alfalfa (Medicago sativa L.).

This study aims to the evaluation of stability and antibacterial properties of the extracted chlorophyll from alfalfa. For this purpose, chlorophylls a and b from alfalfa were extracted by enzymatic and ultrasound methods. The results show that the content of chlorophyll a in alfalfa is higher than chlorophyll b and also the enzymatic method demonstrates higher yield in chlorophyll extraction. In the present study, the chlorophyll stability was evaluated in different conditions including temperature (-18, 4 and 25 °C), time (15, 30 and 45 days), pH (4.5 and 5.5) and NaCl concentration (50, 100 and 150 mM). Also, antibacterial effects were investigated at different concentrations of chlorophyll (20, 40, 60 and 100 µM) against some bactriaes by agar disk diffusion and microdilution (MIC and MBC) methods. The results demonstrate that 50 mM of NaCl, temperature -18 °C, pH = 4.5 and time 15 days are associated with the highest chlorophyll a and b contents. Furthermore, the resistance of bacterias in agar disk diffusion and microdilution methods observe Listeria < Staphylococcus < Salmonella < Escherichia < Pseudomonas and Listeria<(Staphylococcus = Escherichia = Salmonella)

Mosquito surveillance and the first record of morphological and molecular-based identification of invasive species Aedes (Stegomyia) aegypti (Diptera: Culicidae), southern Iran.

Ae. aegypti is an important vector for transmission of some dangerous arboviral diseases, including Dengue Fever. The present study was conducted (from August 2017 to January 2020) to survey the fauna of Culicine mosquitoes, emphasizing the existence of this invasive species in oriental parts of the country located near the Persian Gulf. Different sampling methods were used to collect all life stages of the mosquito. After morphological identification, a molecular study based on Cytochrome Oxidase (COI) gene-specific primers was performed. Then, the COI gene was sequenced via the Sanger method. A total of 4843 adults and 11,873 larvae were collected (8 species of Culex, one species of Culiseta, and 5 species of Aedes). Fifty-five Ae. aegypti specimens (8 adults and 47 larvae) were identified. Based on the biology and ecological requirements of Ae. aegypti, the possibility of the permanent establishment of this species in the tropical climate of the region is very likely. Considering the detection of this invasive vector mosquito species in Iran and the high incidence of some arboviral diseases in the neighboring countries, and continuous movements of the settlers of these areas, potential outbreaks of arboviral diseases can be predicted. Planning and implementing an immediate surveillance and control program of the vector mosquito is vital to prevent the permanent establishment of this invasive vector mosquito species in southern Iran.

Effect of clover sprouts protein hydrolysates as an egg substitute on physicochemical and sensory properties of mayonnaise.

Mayonnaise is a semi-solid oil-in-water emulsion that in addition to eggs other stabilizers and thickeners are used as emulsifiers for better stability. Although eggs are an important ingredient in the production of mayonnaise, the health problems associated with the use of eggs is increasing due to their high cholesterol content. The aim of this study was to evaluate the feasibility of clover sprout protein hydrolysates (CSPH) to replace eggs for the production mayonnaise. First, CSPH was produced using alcalase and flavourzyme enzyme, and in order to find the best enzyme, the degree of hydrolysis (DH) and protein recovery (PR) were determined. Then four mayonnaise treatments included, T1: control (egg 9%), T2: egg 6%+ CSPH 3%, T3: egg 3%+ CSPH 6%, T4: egg 0%+ CSPH 9% was prepared and the stability, viscosity, physicochemical, textural, and sensory properties of mayonnaise was investigated. The samples containing CSPH showed that CSPH had high essential amino acids, CSPH from alcalase enzyme had higher amounts of protein, DH, PR, and increasing hydrolysis time had a positive effect on these parameters (p < .05); therefore, CSPH from alcalase enzyme was used for the production mayonnaise. The stability, viscosity, firmness, adhesion of texture, and pH increased with increasing CSPH, while the brightness, acidity, and sensory score of the samples decreased (p < .05). In general, T3 had an acceptable quality in terms of the studied characteristics, but sensory score in T4 could not be confirmed. Hence, by replacing eggs with CSPH up to 6%, mayonnaise with appropriate physicochemical and sensory properties can be produced. Therefore, the formulation egg 3%+ CSPH 6% is an appropriate choice to produce mayonnaise for consumers who are on a restricted diet to eat foods containing eggs.

Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis.

BACKGROUND: Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. OBJECTIVE: The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. METHODS: Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. RESULTS: Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. CONCLUSION: Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.

Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis.

Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.

Prevalence of pressure ulcers in africa: A systematic review and meta-analysis.

BACKGROUND: A recent global review of pressure ulcers contained no studies from Africa. OBJECTIVE: To identify the prevalence and incidence of pressure ulcers in Africa. DATA SOURCES: Bibliographic databases, African specific databases, grey literature. STUDY ELIGIBILITY CRITERIA: Studies with prevalence or incidence data of pressure ulcers from Africa since the year 2000. PARTICIPANTS: Any age, including children, in any setting, specifically including hospital patients from any clinical area but not restricted to hospital settings. STUDY APPRAISAL AND SYNTHESIS METHODS: Hoy score for bias, Joanna Briggs Institute Critical Appraisal Instrument. METHOD: We followed the PRISMA guideline for systematic reviews. We searched Embase, Medline, Scopus, CINHAL, Google Scholar, specialist African databases and grey literature for studies reporting incidence or prevalence data. RESULTS: Nineteen studies met the inclusion criteria and were included in the study. Point prevalence rates varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11%, for grades II-IV 5%. For spinal injury units the pooled prevalence was 44%. LIMITATIONS: restricted to English, French and Arabic. CONCLUSION: Prevalence of pressure ulcers in Africa reported here is similar to figures from a recent review of prevalence in Europe and two recent global reviews of hospitalised patients. Prevalence of pressure ulcers in spinal cord injury patients is similar to figures from a review of developing countries. The reporting of prevalence is lacking in detail in some studies. Studies using an observational design employing physical examination of patients showed higher prevalence than those relying on other methods such as medical notes or databases. IMPLICATIONS OF KEY FINDINGS: Further prevalence and incidence studies are needed in Africa. Reporting of such studies should ensure items in the "Checklist for Prevalence Studies" from Joanna Briggs Institute (or similar well regarded resources) are addressed and the PICOS model and PRISMA guidelines are employed. SYSTEMATIC REVIEW REGISTRATION NUMBER: Prospero registration number CRD42020180093.

Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction.

The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.

Biting and resting behaviour of malaria vectors in Bandar-Abbas County, Islamic Republic of Iran.

BACKGROUND: Blood feeding and resting behaviour of malaria vectors are the most influential factors in malaria transmission. AIMS: To measure blood feeding and resting behaviour, conventional mosquito sampling methods were performed in an area with potential for malaria transmission. METHODS: Adult mosquitoes were collected monthly from indoor/outdoor places by conventional sampling methods, and larval habitats were investigated. Enzyme-linked immunosorbent assay was used to measure the human blood index (HBI) of the mosquitoes. RESULTS: Anopheles stephensi, Anopheles culicifacies, Anopheles dthali and Anopheles fluviatilis, were collected. Overall, 1249 female Anopheles mosquitoes were captured on human and animal baits, but no human-vector contact occurred indoors. A. dthali, A. fluviatilis and A. culicifacies showed a greater tendency to outdoor resting places in contrast to A. stephensi, which had a propensity to indoor resting places. The seasonal biting activities of all species occurred at average temperatures between 23 and 27°C. HBI was measured as 27.2%, 20.7%, 19.1%, and 23.0% for A. fluviatilis, A. stephensi, A. culicifacies and A. dthali, respectively. CONCLUSION: Vector control strategy depends upon mosquito behaviour. Therefore, using appropriate sampling methods based on mosquito behaviour is critical for malaria control planning. Exophilic/exophagic habit of mosquito vectors leads to fewer human bites, resulting in biting protection. Exophilic behaviour also requires specific larvicidal operations in order to prevent and control malaria transmission.

Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis.

BACKGROUND: Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. OBJECTIVE: This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. METHODS: A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. RESULTS: A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] -0.28, 95% CI -0.38 to -0.18 and SMD -0.26, 95% CI -0.35 to -0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD -0.10, 95% CI -0.17 to 0.03 and SMD -0.17, 95% CI -0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. CONCLUSIONS: Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes.

Modification of Nickel Surfaces by Bismuth: Effect on Electrochemical Activity and Selectivity toward Glycerol.

Herein, we study the effect of adding bismuth to Ni-nanostructured catalysts (NixBi1-x, x = 100-90 at. %) for glycerol electro-oxidation in alkaline solution by combining physiochemical, electrochemical, and in situ infrared spectroscopy techniques, as well as continuous electrolysis with HPLC (high-performance liquid chromatography) product analysis. The addition of small quantities of Bi (<20 at. %) to Ni nanoparticles led to significant activity enhancement at lower overpotentials, with Ni90Bi10 displaying an over 2-fold increase compared to Ni. Small quantities of bismuth actively affected the reaction selectivity of Ni by suppressing the pathways with C-C bond cleavage, hindering the production of carbonate and formate and improving the formation of tartronate, oxalate, and glycerate. Furthermore, the effect of aging on NixBi1-x catalysts was investigated, resulting in structural modification from the Ni-Bi double shell/core structure to Bi decorated on the folded Ni sheet, thus enhancing their activity twice after 2 weeks of aging. NiBi catalysts are promising candidates for glycerol valorization to high-value-added products.

Development and preliminary evaluation of a new anatomically based prosthetic alignment method for below-knee prosthesis.

The objectives of current study were to a) assess similarities and relationships between anatomical landmark-based angles and distances of lower limbs in unilateral transtibial amputees and b) develop and evaluate a new anatomically based static prosthetic alignment method. First substudy assessed the anthropometrical differences and relationships between the lower limbs in the photographs taken from amputees. Data were analyzed via paired t-test and regression analysis. Results show no significant differences in frontal and transverse planes. In the sagittal plane, the anthropometric parameters of the amputated limb were significantly correlated to the corresponding variables of the sound limb. The results served as bases for the development of a new prosthetic alignment method. The method was evaluated on a single-subject study. Prosthetic alignment carried out by an experienced prosthetist was compared with such alignment adjusted by an inexperienced prosthetist but with the use of the developed method. In sagittal and frontal planes, the socket angle was tuned with respect to the shin angle, and the position of the prosthetic foot was tuned in relation to the pelvic landmarks. Further study is needed to assess the proposed method on a larger sample of amputees and prosthetists.

Prevalence of pressure ulcers in long-term care: a global review.

OBJECTIVE: To identify and update the prevalence and incidence of pressure ulcers (PUs) in several countries, in people with long-term conditions resident in care homes or nursing homes. METHODS: We followed the PRISMA guideline for systematic reviews. However, due to funding constraints we do not claim this review to be systematic but it is a narrative review informed by PRISMA. Medline, Embase and CINHAL were searched for observational studies reporting incidence or prevalence data. Data reported relevant head-to-toe examination of PUs in residence in care or nursing homes. Internal and external validity of the included studies were assessed using the checklist devised by Hoy et al.1. RESULTS: Inclusion criteria was met by 17 studies and included in the study. Some studies gave a full breakdown by category, some only gave overall figures, and others excluded category I PUs. However, within those constraints certain patterns are clear. Prevalence rates varied from 3.4-32.4%. Large differences in prevalence in different countries were not explained by methodological differences. While some countries, such as Germany, the Netherlands and the US had robust data, other countries, such as the UK, had none. CONCLUSION: PUs are a common problem in long-term care. However, there are substantial differences between countries and many countries have no published data.

Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews.

OBJECTIVE: Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions. METHODS: Scoping review methodological frameworks were used. Electronic bibliographic databases were searched (inception to November 2016) for systematic reviews of fatigue interventions in long term conditions. Inclusion criteria were: long term physical health condition; review focus on fatigue management; objective and systematic review process; primary review outcome is fatigue. Articles focussing on surgical interventions or treatments thought to trigger fatigue were excluded. A narrative synthesis was performed. RESULTS: Of 115 full texts screened, 52 reviews were included. Interventions were categorised as pharmacological and non-pharmacological (exercise, psychological/behavioural and complementary medicine). Pharmacological interventions did not consistently demonstrate benefit, except for anti-TNFs and methylphenidate which may be effective at reducing fatigue. Non-pharmacological interventions such as graded exercise and fatigue-specific psychological interventions may be effective, but heterogeneous intervention components limit conclusions. 'Complementary medicine' interventions (e.g. Chinese herbal medicines) showed promise, but the possibility of publication bias must be considered. CONCLUSIONS: Further research is necessary to inform clinical practice. The reported effectiveness of some interventions across inflammatory health conditions, such as anti-TNFs, aerobic exercise, and psychologically based approaches such as CBT, highlights a potential transdiagnostic avenue for fatigue management. More novel strategies that may be worth exploring include expressive writing and mindfulness, although the mechanisms for these in relation to fatigue are unclear. More work is needed to identify transdiagnostic mechanisms of fatigue and to design interventions based on these.

A systematic review of variables used to assess clinically acceptable alignment of unilateral transtibial amputees in the literature.

Prosthetic alignment is a subjective concept which lacks reliability. The outcome responsiveness to prosthetic alignment quality could help to improve subjective and instrument assisted prosthetic alignment. This study was aimed to review variables used to assess clinically acceptable alignment in the literature. The search was done in some databases including: Google Scholar, PubMed, EBSCO, EMBASE, ISI Web of Knowledge and Scopus. The first selection criterion was based on abstracts and titles to address the research questions of interest. The American Academy of Orthotics and Prosthetics checklists were used for paper risk of bias assessment. A total of 25 studies were included in this study. Twenty-four studies revealed the critics of standing position or walking to locate clinically acceptable alignment, only one study measured outcomes in both situations. A total of 253 adults with transtibial amputations and mean age of 48.71 years participated in included studies. The confidence level of included studies was low to moderate, and before-after trial was the most common study design (n = 19). The joint angle, load line location with respect to joints and center of pressure-related parameters were reported as sensitive outcomes to prosthetic alignment quality in standing posture. The amount of forces at various parts of gait cycle and time of events were sensitive to prosthetic alignment quality during walking. Standing balance and posture and temporal parameters of walking could help to locate clinically acceptable alignment.