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Abstract Aims This study explored the reliability, validity and perceived comfort of a novel thumb pressure measure and calculation of a toe–thumb index to identify their suitability as an adjunct or alternatives to ankle–brachial and toe–brachial indices. Methods and Results Repeated manual thumb and toe systolic blood pressures were conducted using two raters, over two time points, on 34 healthy participants. Concurrent automated toe, thumb and brachial systolic blood pressures as well as comfort ratings for these measures (using a 10 mm visual analogue scale) were captured once by a research assistant. Automated thumb and brachial measures showed fair correlation (ρ = 0.36, p = 0.03) and a toe–thumb index and toe–brachial index good correlation (ρ = 0.62, p

Evidence suggests that the gut microbiome may play a role in multiple sclerosis (MS). However, the majority of the studies have focused on gut bacterial communities; none have examined the fungal microbiota (mycobiota) in persons with pediatric-onset multiple sclerosis (POMS). We examined the gut mycobiota in persons with and without POMS through a cross-sectional examination of the gut mycobiota from 46 participants’ stool samples (three groups: 18 POMS, 13 acquired monophasic demyelinating syndromes [monoADS], and 15 unaffected controls). Using metataxonomic sequencing of the fungal internal transcribed spacer region 2, the fungal profiles were compared between participants using visualizations, statistical tests, and predictive analysis. While the mycobiome α- (Shannon and inverse Simpson indices) and β-diversity differed across the three groups [analysis of variance (ANOVA), p

Background: Flexible pediatric flatfoot is an anatomical presentation of the foot that is common in children, and its functional impact raises long-term uncertainty. Functional re-education includes strengthening and stretching exercises for the intrinsic and extrinsic musculature of the foot, proposed as an effective conservative treatment. However, to date, there is no systematic review examining its effectiveness in the pediatric population. This systematic review aims to evaluate the effectiveness of functional re-education as a conservative treatment for flexible pediatric flatfoot, determining which exercises are most effective. Methods: A search (PROSPERO: CRD42023391030) was conducted across six databases, resulting in an initial total of 327 studies. Of these, 11 randomized controlled trials (RCTs) met the inclusion criteria, resulting in a sample of 419 children aged 6 to 14 years with a diagnosis of flexible flatfoot. The evaluated studies present variations in diagnostic criteria, types of exercises, and treatment duration. Results: The results indicate that functional re-education is effective in improving the symptomatology and functionality of the foot in children. In particular, exercises targeting the intrinsic musculature proved to be among the most effective treatments, improving the structural development of the medial longitudinal arch. The reviewed literature recommends a minimum treatment duration of eight weeks. Conclusions: Functional re-education represents an effective conservative treatment option for flexible flatfoot in children, positioning it as the treatment of choice for this condition.

Context: The incidence and recurrence rate of hamstring strain injuries remain persistently high, with recurrent injuries leading to increased time lost during play and extended recovery periods compared with initial injury. Ultrasound imaging assesses important factors such as hamstring fascicle length (FL), pennation angle (PA), cross-sectional area (CSA), muscle thickness (MT), echo intensity (EI), and shear wave elastography (SWE), all impacting athletic performance. However, its reliability must be established before employing any measurement tool in research or clinical settings. Objectives: To determine the reliability and measurement error of ultrasound for assessing hamstring FL, PA, CSA, MT, EI, and SWE among healthy adults and athletes; to synthesize the information regarding the operationalization of ultrasound. Evidence Acquisition: A systematic literature search was done from January 1990 to February 5, 2023, to identify reliability and validity studies of hamstring ultrasound assessment published in peer-reviewed journals with identifiable methodology of outcome measures. Evidence Synthesis: Intraclass correlation coefficient measurement of 14 included studies reported moderate to excellent intrarater, interrater, and test–retest reliabilities of FL, PA, and MT regardless of the site of muscle testing, probe size, and setting, state of muscle, and use of different techniques in the extrapolation of FL. Good to excellent test–retest reliability rates for all hamstring anatomic CSA along midmuscle and different percentages of thigh length using panoramic imaging. Good intrarater reliability of EI regardless of gender and orientation of the probe but with excellent intrarater reliability in transverse scan using maximum region of interest. Good intrarater, interrater, and interday repeatability on SWE with the muscle in a stretched position. Conclusion: Evidence from studies with a predominantly low risk of bias shows that ultrasound is a reliable tool to measure hamstring FL, PA, CSA, MT, EI, and SWE in healthy adults and athletes under various experimental conditions. [ABSTRACT FROM AUTHOR]

The Greenland Ice Sheet (GrIS) is losing mass as the climate warms through both increased meltwater runoff and ice discharge at marine-terminating sectors. At the ice sheet surface, meltwater runoff forms a dynamic supraglacial hydrological system which includes stream and river networks and large supraglacial lakes (SGLs). Streams and rivers can route water into crevasses or into supraglacial lakes with crevasses underneath, both of which can then hydrofracture to the ice sheet base, providing a mechanism for the surface meltwater to access the bed. Understanding where, when, and how much meltwater is transferred to the bed is important because variability in meltwater supply to the bed can increase ice flow speeds, potentially impacting the hypsometry of the ice sheet in grounded sectors, and iceberg discharge to the ocean. Here we present a new, physically based, supraglacial hydrology model for the GrIS that is able to simulate (a) surface meltwater routing and SGL filling; (b) rapid meltwater drainage to the ice sheet bed via the hydrofracture of surface crevasses both in and outside of SGLs; (c) slow SGL drainage via overflow in supraglacial meltwater channels; and, by offline coupling with a second model, (d) the freezing and unfreezing of SGLs from autumn to spring. We call the model the Supraglacial Hydrology Evolution and Drainage (or SHED) model. We apply the model to three study regions in southwest Greenland between 2015 and 2019 (inclusive) and evaluate its performance with respect to observed supraglacial lake extents and proglacial discharge measurements. We show that the model reproduces 80 % of observed lake locations and provides good agreement with observations in terms of the temporal evolution of lake extent. Modelled moulin density values are in keeping with those previously published, and seasonal and inter-annual variability in proglacial discharge agrees well with that which is observed, though the observations lag the model by a few days since they include transit time through the subglacial system, while the model does not. Our simulations suggest that lake drainage behaviours may be more complex than traditional models suggest, with lakes in our model draining through a combination of both overflow and hydrofracture and with some lakes draining only partially and then refreezing. This suggests that, in order to simulate the evolution of Greenland's surface hydrological system with fidelity, a model that includes all of these processes needs to be used. In future work, we will couple our model to a subglacial model and an ice flow model and thus use our estimates of where, when, and how much meltwater gets to the bed to understand the consequences for ice flow.

Global Navigation Satellite System (GNSS) observations and ground-based timelapse photography obtained over the record-high 2019/2020 melt season are combined to characterise the flexure and fracture behaviour of a previously formed doline on George VI Ice Shelf, Antarctica. The GNSS timeseries shows a downward vertical displacement of the doline centre with respect to the doline rim of ~60 cm in response to loading from a central meltwater lake. The GNSS data also show a tens-of-days episode of rapid-onset, exponentially decaying horizontal displacement, where the horizontal distance between the doline rim and its centre increases by ~70 cm. We interpret this event as the initiation and/or widening of a fracture, aided by stress perturbations associated with meltwater loading in the doline basin. Viscous flexure modelling indicates that the meltwater loading generates tensile surface stresses exceeding 75 kPa. This, together with our timelapse photos of circular fractures around the doline, suggests the first such documentation of meltwater-loading-induced ‘ring fracture’ formation on an ice shelf, equivalent to the fracture type proposed as part of the chain-reaction lake drainage process involved in the 2002 breakup of the Larsen B Ice Shelf.

Surface melting on the Antarctic Ice Sheet has been monitored by satellite microwave radiometry for over 40 years. Despite this long perspective, our understanding of the microwave emission from wet snow is still limited, preventing the full exploitation of these observations to study supraglacial hydrology. Using the Snow Microwave Radiative Transfer (SMRT) model, this study investigates the sensitivity of microwave brightness temperature to snow liquid water content at frequencies from 1.4 to 37 GHz. We first determine the snowpack properties for eight selected coastal sites by retrieving profiles of density, grain size and ice layers from microwave observations when the snowpack is dry during wintertime. Second, a series of brightness temperature simulations is run with added water. The results show that (i) a small quantity of liquid water (≈0.5 kg m−2) can be detected, but the actual quantity cannot be retrieved out of the full range of possible water quantities; (ii) the detection of a buried wet layer is possible up to a maximum depth of 1 to 6 m depending on the frequency (6–37 GHz) and on the snow properties (grain size, density) at each site; (iii) surface ponds and water-saturated areas may prevent melt detection, but the current coverage of these waterbodies in the large satellite field of view is presently too small in Antarctica to have noticeable effects; and (iv) at 1.4 GHz, while the simulations are less reliable, we found a weaker sensitivity to liquid water and the maximal depth of detection is relatively shallow ( m) compared to the typical radiation penetration depth in dry firn (≈1000 m) at this low frequency. These numerical results pave the way for the development of improved multi-frequency algorithms to detect melt intensity and the depth of liquid water below the surface in the Antarctic snowpack.

The naturally abundant, enantiomerically pure cyclitol quinic acid has been converted into a synthetically useful enone in nearly quantitative yield using the operationally straightforward and reproducible protocols reported herein. The latter compound, which was obtained in multigram quantities, engages in a diastereoselective 1,2-addition reaction with a hydrazone-based nucleophile. Furthermore, a readily derived α-iodoenone participates in both cross-coupling and α,β-annulation reactions. The results reported here emphasize that the now practically accessible cyclohexenones are useful, enantiomerically pure building blocks for organic synthesis.

The once-contiguous Ellesmere Ice Shelf, first reported in writing by European explorers in 1876, and now almost completely disintegrated, has rolling, wave-like surface topography, the origin of which we investigate using a viscous buckling instability analysis. We show that rolls can develop during a winter season (~ 100 d) if sea-ice pressure (depth-integrated horizontal stress applied to the seaward front of the Ellesmere Ice Shelf) is sufficiently large (1 MPa m) and ice thickness sufficiently low (1–10 m). Roll wavelength initially depends only on sea-ice pressure, but evolves over time depending on amplitude growth rate. This implies that a thinner ice shelf, with its faster amplitude growth rate, will have a shorter wavelength compared to a thicker ice shelf when sea-ice pressure is equal. A drawback of the viscous buckling mechanism is that roll amplitude decays once sea-ice pressure is removed. However, non-Newtonian ice rheology, where effective viscosity, and thus roll change rate, depends on total applied stress may constrain roll decay rate to be much slower than growth rate and allow roll persistence from year to year. Whether the viscous-buckling mechanism we explore here ultimately can be confirmed as the origin of the Ellesmere Ice Shelf rolls remains for future research.

Abstract Background Baby food marketing undermines breastfeeding by influencing women’s attitudes and decision-making favourably toward commercial baby food. This study aimed to explore the effects of various baby food marketing techniques on Thai mothers’ opinions about commercial milk formulas (CMF) and commercial complementary foods (CCF) and their infant and young child feeding behaviours. Methods This study used a cross-sectional survey employing the World Health Organization (WHO) NetCode Toolkit Protocol for Periodic Assessment, and the United Nations International Children’s Emergency Fund (UNICEF) Multiple Indicator Cluster Survey to collect data on mothers’ experience with and their opinion on the various types of marketing of CMF and CCF, and their feeding behaviour. Data collection used structured interviews of mothers with children aged two years or below attending 33 health facilities in Bangkok. Univariable and multivariable regression analysis then investigated links between mothers’ reported exposure to baby food marketing and their infant and young child feeding behaviours, employing a semantic scale and considering key sociodemographic and other variables. Results Three hundred and thirty mothers were surveyed in Bangkok. Around 90% reported experiencing exposure to at least one type of baby food marketing during the previous six months, mostly from electronic media. More than half of the women had positive opinions of CMF. Virtually all children had been breastfed initially, but 74.6% were given CMF and 72.8% stopped breastfeeding before six months. Multivariable analysis showed that mothers who lived in a couple were significantly less likely to favour CMF, and mothers in middle-income households and those who had received advice about CMF from others were more likely to have a favourable opinion. Mothers in formal employment were over six times more likely to feed formula than those not in employment. Women who experienced baby food marketing at health facilities were four times more likely to feed CMF to their children than those not experiencing such marketing. Conclusions Specific types of baby food marketing were strongly linked to mothers’ opinions on and use of CMF in Bangkok, Thailand. It is recommended that breastfeeding policies in health facilities and employment are fully implemented and enforced.

Abstract Background Ankle traumas are common presenting injuries to emergency departments in Australia and worldwide. The Ottawa Ankle Rules (OAR) are a clinical decision tool to exclude ankle fractures, thereby precluding the need for radiographic imaging in patients with acute ankle injury. Previous studies support the OAR as an accurate means of excluding ankle and midfoot fractures, but have included a paediatric population, report both the ankle and mid-foot, or are greater than 5 years old. This systematic review and meta-analysis aimed to update and assess the existing evidence of the diagnostic accuracy of the Ottawa Ankle Rule (OAR) acute ankle injuries in adults. Methods A systematic search and screen of was performed for relevant articles dated 1992 to 2020. Prospective and retrospective studies documenting OAR outcomes by physicians to assess ankle injuries were included. Critical appraisal of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Outcomes related to psychometric data were pooled using random effects or fixed effects modelling to calculate diagnostic performance of the OAR. Between-study heterogeneity was assessed using the Higgins I2 test, with Spearman’s correlation test for threshold effect. Results From 254 unique studies identified in the screening process, 15 were included, involving 8560 patients from 13 countries. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were 0.91 (95% CI, 0.89 to 0.92), 0.25 (95% CI, 0.24 to 0.26), 1.47 (95% CI, 1.11 to 1.93), 0.15 (95% CI, 0.72 to 0.29) and 10.95 (95% CI, 5.14 to 23.35) respectively, with high between-study heterogeneity observed (sensitivity: I2 = 94.3%, p

Abstract Breast milk substitute (BMS) marketing harms breastfeeding and public health. To control BMS marketing, the Member States of the World Health Organization is called upon to adopt all provisions of the International Code of Marketing of Breastmilk Substitutes (the Code) into national law. In 2017, Thailand adopted many provisions of the Code through the Control of Marketing Promotion of Infant and Young Child Food Act B.E. 2560 (the Act), including the establishment of a compliance monitoring system and enforcement mechanisms. Nevertheless, recent research showed widespread violations. This study aims to assess gaps in the monitoring system and the Act's enforcement in its first three years of operation. This qualitative research study employed in‐depth interviews between April and June 2020 with 34 key informants (KIs) from the Thai government, academia and civil society organisations. KIs identified gaps in six areas that could be mitigated to increase compliance with the Act. These gaps are unclear provisions on coverage of the Act; communications with retailers and the public; lack of strong direction and processes; inadequate budget allocations; skilled and confident human resources; and external factors which facilitate BMS marketing. Recommendations may be relevant for other countries and include revising and clarifying the Act, developing targeted communication strategies; providing clear monitoring direction including through setting key performance indicators related to the Act; and providing sufficient budget and training for authorised and support officers. Strengthening the health system and workplace support for breastfeeding and social marketing would also help address wider structural factors.

Abstract Background The COVID-19 outbreak has spread to almost every country around the world and caused more than 3 million deaths. The pandemic has triggered enormous disruption in people’s daily lives with profound impacts globally. This has also been the case in Australia, despite the country’s comparative low mortality and physical morbidity due to the virus. This scoping review aims to provide a broad summary of the research activity focused on mental health during the first 10 months of the pandemic in Australia. Results A search of the Australian literature was conducted between August-November 2020 to capture published scientific papers, online reports and pre-prints, as well as gaps in research activities. The search identified 228 unique records in total. Twelve general population and 30 subpopulation group studies were included in the review. Conclusions Few studies were able to confidently report changes in mental health driven by the COVID-19 context (at the population or sub-group level) due to a lack of pre-COVID comparative data and non-representative sampling. Never-the-less, in aggregate, the findings show an increase in poor mental health over the early period of 2020. Results suggest that young people, those with pre-existing mental health conditions, and the financially disadvantaged, experienced greater declines in mental health. The need for rapid research appears to have left some groups under-researched (e.g. Culturally and Linguistically Diverse populations and Indigenous peoples were not studied), and some research methods under-employed (e.g. there was a lack of qualitative and mixed-methods studies). There is a need for further reviews as the follow-up results of longitudinal studies emerge and understandings of the impact of the pandemic are refined.

The educational benefits of embedding hands-on experience in higher education curriculum are widely recognized (Beard & Wilson, 2013). However, to optimize the learning from these opportunities, they need to be grounded in empirical learning theory. The purpose of this study was to examine the characteristics of internships in Ontario colleges and universities, and to assess the congruence between the components of these internships and Kolb's (1984) experiential learning framework. Information from 44 Ontario universities and colleges, including 369 internship program webpages and 77 internship course outlines, was analyzed. The findings indicated that internship programs overemphasize the practical aspect of the experience at the expense of linking theory and practice. To optimize experiential education opportunities, recommendations include establishing explicit learning activities consistent with each experiential learning mode, including practice, reflection, connecting coursework and practical experience, and implementing creative ideas in practice.