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More than 25 years have passed since the US Food and Drug Administration approved IV recombinant tissue plasminogen activator (alteplase) for the treatment of acute ischemic stroke. This landmark decision brought a previously untreatable disease into a new therapeutic landscape, providing inspiration for clinicians and hope to patients. Since that time, the use of alteplase in the clinical setting has become standard of care, continually improving with quality measures such as door-to-needle times and other metrics of specialized stroke unit care. The past decade has seen more widespread use of alteplase in the prehospital setting with mobile stroke units and telestroke and beyond initial time windows via the use of CT perfusion or MRI. Simultaneously, the position of alteplase is being challenged by new lytics and by the concept of its bypass altogether in the era of endovascular therapy. We provide an overview of alteplase, including its earliest trials and how they have shaped the current therapeutic landscape of ischemic stroke treatment, and touch on new frontiers for thrombolytic therapy. We highlight the critical role of thrombolytic therapy in the past, present, and future of ischemic stroke care.

Purpose This paper aims to present the current state of evidence regarding the mental health literacy of paramedics and student paramedics and whether mental health literacy affects the care that paramedics provide to their patients with mental illness. Design/methodology/approach Embase, PubMed, Medline and Google Scholar were searched for recent (2010–2020) English language published articles using the key phrases paramedic AND/OR ambulance AND mental health AND mental health literacy. Additional searches of the reference lists of included articles were undertaken. A descriptive thematic analysis was used to arrive at a narrative synthesis of the study findings. Findings The emergency medical services system has taken a primary role in the care of patients with mental illness but has limited capacity for non-emergency psychosocial situations. Negative and judgemental attitudes amongst paramedics towards patients with mental illness is a significant issue and remains a barrier to patients seeking medical care for mental illness. Improved care provision and patient engagement might result from specific education aimed to better enhance paramedics’ mental health literacy. Originality/value This literature review provides insights into the current practice of mental health training for Australian undergraduate paramedic science students and the implications for patient care. Recommendations for educational strategies are provided.

In Australia, exercise practitioners (i.e., clinical professionals specializing in exercise assessment and delivery) are increasingly recognized as core mental health team members. In response to the COVID-19 pandemic, exercise practitioners, like other mental health professions, have had to adapt methods of clinical service delivery to ensure social distancing and reduce risk of community transmission. As such, telehealth interventions have rapidly replaced most face-to-face services. To date, evidence surrounding the application of telehealth exercise interventions for people living with mental illness is scarce, and currently there is no consensus or recommendations on how exercise practitioners can provide telehealth services for this population. As such, the aim of this article is to draw on existing research and expert opinion to provide practical and service-based guidance for exercise practitioners delivering telehealth services to people with mental illnesses. Specifically, we explore the potential benefits of telehealth exercise interventions, the various challenges and considerations of telehealth exercise among those with mental illness, and some practical solutions to guide exercise practitioners in delivering telehealth services.

Neck of femur (NOF) fractures present a significant challenge for healthcare systems and are associated with major complications and high mortality. Hospital clinical pathways aim to improve care and optimise outcomes for individuals sustaining NOF fractures; however, these pathways exclude the pre-hospital management of suspected NOF fractures. Therefore, there remains a lack of evidenced-based standardisation for pre-hospital management. To date, research into pre-hospital management of NOF fractures has mostly focussed on pain relief, with very little research examining immobilisation techniques. This is despite immobilisation offering great clinical benefit for other long bone fractures. Unlike hospital clinical pathways that undergo annual reports and reviews, pre-hospital guidelines for NOF fracture immobilisation have received little attention in the past decade. Given advances in research-informed practice for pre-hospital management of other fractures, it seems timely and pertinent to examine current clinical practice guidelines for NOF fractures, focusing on the appropriateness of current immobilisation techniques.

PurposePhysical activity is increasingly recognised as critical to improving physical and mental health (MH). Understanding the education and training requirements of exercise professionals will support better integration of these emerging MH professionals within the multidisciplinary MH team. The purpose of this study was to determine the exposure to, knowledge and attitudes of final year exercise physiology students towards people with mental illness (MI).Design/methodology/approachStudent exposure to and knowledge and attitudes of people living with MH were assessed via a 24-item online questionnaire.FindingsIn total,n= 63 out of 78 eligible students participated (81%). Of the participants, 81% (n= 51) showed a favourable attitude towards people with MI and 68% (n= 43) of participants had good knowledge of topics relating to MI. Significant correlations existed between the total score for attitude and any exposure to MH issues and having undertaken placement as part of university training and knowledge and total scores. Further training and education are needed to better equip exercise physiology graduates to work with people with MI.Originality/valueThis is the first study to examine the attitudes and knowledge of exercise physiology students towards people living with MI and their association with exposure to MI. Given the growing number of exercise professionals being integrated into multidisciplinary MH teams, this study may help to direct the delivery of associated training and education services.

Over the past 40 years there has been a steady rise in the number of people with chronic kidney disease due mainly to a significant increase in the number of people with diabetic kidney disease (DKD). Current treatments (blood pressure control, blood sugar control, and renin-angiotensin-aldosterone system inhibitors) have had a significant impact on slowing progression of DKD. But the continued rise illustrates that there is a great need for new medications. Recently, a number of potentially reno-protective medicines have been studied. In this review, these new medications are discussed with respect to both their reported benefits and possible risks.

Sleep is essential in the preparation for, and the recovery from, training and competition. Despite being important for all individuals, young athletes are considered an at-risk group for reduced sleep duration and quality. The purpose of this review is to synthesise current literature relating to sleep duration and quality in young (14-25 years) athletes. Specifically, typical sleep and wake patterns, factors affecting sleep and wake patterns, and the consequences of altered sleep and wake patterns in young athletes are discussed. Scheduling training and competition in the afternoon or evening appears to result in reduced sleep duration due to less time in bed. Evidence suggests that young athletes who obtain less than 8 h of sleep per night are at a higher risk of musculoskeletal injury. An increase in sleep duration above habitual nightly sleep may be associated with favourable performance in young athletes; however, the associations between sleep quality and performance- and health-related outcomes remain unclear.

Objective To systematically identify, appraise, and examine evidence regarding the effects of therapeutic tape on pain and function in individuals with lateral epicondylalgia (LE). Methods Five electronic databases were systematically searched up to March 2018. Full-text, peer-reviewed, English-language studies were included if they had an LE population, a standalone tape condition, and an outcome related to pain or function. Results Eight out of 2022 screened studies were included. Three studies demonstrated immediate (i.e. within 1 h) improvements in pain and pain-free grip strength following diamond deloading rigid tape. One study reported immediate improvements in proprioception following transverse rigid tape. The immediate effects of longitudinal kinesiotape were inconsistent. One study reported improvements in pain and pain-free grip strength, while another study reported no effect on pain, strength, or muscle activity. Two studies examined short-term (i.e. within six weeks) kinesiotape application. One study reported two weeks of longitudinal kinesiotape improved pain and maximum grip strength. The other study reported one week of diamond kinesiotape improved patient-reported pain and function, but not maximum grip strength. Conclusions In individuals with LE, diamond deloading rigid tape may immediately improve pain and strength. There is conflicting evidence regarding kinesiotape effects in both immediate and short-term timeframes.

The substantial physical health disadvantage experienced by people diagnosed with mental illness is now identified in a growing body of research evidence. The recent promulgation of improved physical health care as a goal of contemporary Australian Mental Health Policy should provide impetus for initiatives and strategies to address this inequity. To date increased knowledge of the problem has not resulted in obvious and sustained changes. The aim of this article is to introduce the role of the Physical Health Nurse Consultant as a potential strategy. The potential contribution and value of this role is considered by reviewing the evidence from the perspective of multiple stakeholders and considering the suitability of nursing to meet the complex needs involved in improving physical health. The requirement for a multi-faceted and comprehensive evaluation is also articulated. A robust, prospective and long-term evaluation plan includes physical health measures, changes in health behaviours, cost-benefit analysis and consumer acceptability to ensure the intervention is effective in the long term. This thorough approach is essential to provide the level of evidence required to facilitate changes at the practice and policy levels. The specialist nursing role presented in this article, subject to the comprehensive evaluation proposed, could become an integral component of a comprehensive approach to addressing physical health inequities in people with mental illness.

Low rates of physical activity, in addition to other poor physical health behaviors, contribute to lower quality of life and increased rates of premature mortality for people living with mental illness. Physical activity reduces this mortality gap while simultaneously improving mood, cognitive function, and symptomology for a variety of psychiatric disorders. While physical activity programs are feasible and acceptable in this population, significant barriers exist that limit long-term adherence. Accredited exercise physiologists (AEPs) are best-placed in Australia to lead physical activity interventions for people living with mental illness. Additionally, AEPs provide an important role in improving culture change within mental health settings by influencing clinicians' attitudes to physical activity interventions. Leading international mental health organizations should collaborate and promote the role of physical activity to increase the provision of such services to people living with mental illness.

BACKGROUND: Exercise is nowadays considered as an evidence-based treatment modality in people with mental illness. Nurses and occupational therapists working in low-resourced mental health settings are well-placed to provide exercise advice for people with mental illness. OBJECTIVES: We examined the current exercise prescription practices employed by Ugandan health care professionals when working with people with mental illness, and identified perceived barriers to exercise prescription and exercise participation for people with mental illness. METHODS: In this study, 31 Ugandan health care professionals 20 men; 31.2 ± 7.1 years completed the Exercise in Mental Illness Questionnaire- Health Professionals Version EMIQ-HP. RESULTS: The vast majority of the respondents 29/31, 94% reported they prescribed exercise at least "occasionally" to people with mental illness. Exercise-prescription parameters used were consistent with those recommended for people with mental illness. Regarding barriers to exercise participation, coping with side effects of psychotropic medication at the individual level and reducing stigma at community level should be prioritized. CONCLUSION: A health care reform to enable collaboration with exercise professionals, such as exercise physiologists or physiotherapists, might increase exercise uptake for people with mental illness, thereby improving health outcomes for this vulnerable population. ispartof: AFRICAN HEALTH SCIENCES vol:19 issue:2 pages:2172-2182 ispartof: location:Uganda status: published

Objective: This study investigated the association between COVID‐19 prevention knowledge and concern and practising preventive behaviour in Australian adults. Methods: Using an online survey, knowledge of Australian COVID‐19 guidelines, concerns about pandemic impact, the practice of preventive behaviours, and sociodemographic variables (i.e. age, gender, information source) were measured. Bivariate analysis and linear regression models were used. Results: A total of 1,491 participants (age 50.5 ±14.9 years, 32.3% males) completed the survey. Higher knowledge and concern scores were associated with a higher practice of preventive behaviour scores (βs:0.47 & 0.08 respectively, p65 years) and women had higher knowledge and practice scores compared to their counterparts. Being younger (

This study investigates changes in willingness to vaccinate against COVID-19 and the effect of the extended restrictions in metropolitan Victoria on this change. Longitudinal and repeated cross-sectional data were collected from online surveys distributed in April, between July and August, and December 2020. Australian adults who were ≥18 years old were recruited through email lists, social media networks, and paid Facebook advertisement. Willingness to vaccinate against COVID-19 was self-reported. The results showed that participants were more willing to vaccinate if the vaccine was safe at survey 1 (longitudinal: adjusted OR (aOR) = 1.88, 95%CI = 1.38, 2.56, cross-sectional: aOR = 3.73, 95%CI = 2.55, 5.45) and survey 2 (longitudinal: aOR = 1.54, 95%CI = 1.19, 2.00, cross-sectional: aOR = 2.48, 1.67, 3.67), compared to survey 3. The change in willingness to vaccinate if the vaccine was safe and effective was not significant for those in Metropolitan Victoria, but was for those living in other Australian locations at survey 1 (OR = 2.13, 95%CI = 1.64, 2.76) and survey 2 (OR = 1.62, 95%CI = 1.30, 2.01), compared to survey 3. Willingness to vaccinate even if a vaccine had not been proven safe decreased at survey 3 (OR = 2.02, 95%CI = 1.14, 3.57) for those living in Metropolitan Victoria. In conclusion willingness to vaccinate against COVID-19 decreased over time among Australians, except for those living in metropolitan Victoria, where an additional strict and prolonged lockdown was implemented around the time of survey 2. Either the experience of the lockdown, or the presence of the COVID-19 virus itself had a positive influence on participants’ willingness to vaccinate, even if such a vaccine was not yet proven to be safe and effective.

First responders often face traumatic and emotionally-taxing incidents in their role. Understanding their mental health and coping capacity is important for wellbeing and continued service delivery. Surf lifesavers and lifeguards are an under researched yet a vital part of the first responder workforce. The recent Senate Report on first responders explored mental health in the leading emergency services personnel in Australia and found a high incidence of mental health difficulties in those who worked or volunteered as emergency responders. However, a significant literature gap exists regarding mental health of surf lifesavers and lifeguards in both the international and Australian context. Here we propose a strategy to address this gap, at the individual, organisational and community level.

Custom-made foot orthoses (FOs) play an integral part in managing foot disorders. Traditional FO fabrication is time-consuming and labor intensive. Three-dimensional (3D) printed FOs save time and cost compared with the traditional manufacturing process. To date, the differences in dimensions and comfort perception of these orthoses have not been compared in a pathological population.Compare the dimensions between 3D-printed and traditionally made FOs and comfort perception between 3D-printed, traditionally made, and no FOs in individuals with flatfeet and unilateral heel pain.Within-subject single-blinded randomized crossover study design.Thirteen participants had custom-made FOs using 3D-printing and traditional processes. Orthotic lengths, widths, arch heights, and heel cup heights were compared. Participants performed walking trials under three conditions: (1) no orthoses, (2) 3D-printed orthoses, and (3) traditionally made orthoses. Comfort perception was recorded. Orthotic dimensions were compared using paired t tests, and comfort perception were compared using one-way multiple analysis of variance and Bonferroni post hoc tests.Three-dimensional-printed orthoses were wider, have higher arch heights, and heel cup heights compared with traditionally made FOs (medium to large effect sizes). There was a difference in comfort perception between the three orthotic conditions, F(12,62) = 1.99, P = 0.04; Wilk Λ = 0.521, ηp2= 0.279. Post hoc tests show that there is no difference in comfort perception between the 3D-printed and traditionally made FOs. Both FOs were significantly more comfortable than no orthoses.Three-dimensional printing seems to be a viable alternative orthotic fabrication option. Future studies should compare the biomechanical effects of 3D-printed and traditionally made FOs.

Controversy around the safety and efficacy of COVID-19 vaccines may lead to low vaccination rates. Survey data were collected in April and August 2020 from a total of 2343 Australian adults. A quarter (n = 575, 24%) completed both surveys. A generalized linear mixed model analysis was conducted to determine whether willingness to vaccinate changed in the repeated sample, and a multinominal logistic regression was conducted in all participants to determine whether willingness to vaccinate was associated with demographics, chronic disease, or media use. Willingness to vaccinate slightly decreased between April (87%) and August (85%) but this was not significant. Willingness to vaccinate was lower in people with a certificate or diploma (79%) compared to those with a Bachelor degree (87%), p &lt, 0.01 and lower in infrequent users of traditional media (78%) compared to frequent users of traditional media (89%), p &lt, 0.001. Women were more likely to be unsure if they would be willing to vaccinate (10%) compared to men (7%), p &lt, 0.01. There were no associations between willingness to vaccinate and age, chronic disease, or social media use. Promotion of a COVID-19 vaccine should consider targeting women, and people with a certificate or diploma, via non-traditional media channels.

Diabetic kidney disease (DKD) continues to be the primary cause of chronic kidney disease in the USA and around the world. The numbers of people with DKD also continue to rise despite current treatments. Certain newer hypoglycemic drugs offer a promise of slowing progression, but it remains to be seen how effective these will be over time. Thus, continued exploration of the mechanisms underlying the development and progression of DKD is essential in order to discover new treatments. Hyperglycemia is the main cause of the cellular damage seen in DKD. But, exactly how hyperglycemia leads to the activation of processes that are ultimately deleterious is incompletely understood. Studies primarily over the past 10 years have provided novel insights into the interplay of hyperglycemia, glucose metabolic pathways, mitochondrial function, and the potential importance of what has been called the Warburg effect on the development and progression of DKD. This review will provide a brief overview of glucose metabolism and the hypotheses concerning the pathogenesis of DKD and then discuss in more detail the supporting data that indicate a role for the interplay of glucose metabolic pathways and mitochondrial function.

Background Burnout and compassion fatigue (CF) are common among mental health practitioners. Accredited Exercise Physiologists (AEPs) provide clinical services to individuals experiencing mental illness, increasing their likelihood of experiencing burnout and CF. Aims To examine the prevalence of burnout and CF among AEPs working with people experiencing mental illness. Methods An anonymous online cross-sectional survey of AEPs working with people experiencing mental illness was distributed via the Exercise and Sports Science Australia Mental Health Special Interest Group Facebook page between July and November 2019. In addition to demographics and caseload data, respondents completed the Professional Quality of Life scale and Oldenburg Burnout Inventory (OLBI). Results are reported using descriptive statistics. Results Sixty-two AEPs (68%, n = 42 female) completed the survey. Most (n = 53, 86%) reported delivering services to consumers with severe mental health conditions. Less than half (n = 27, 44%) reported working in a dedicated mental health facility. Moderate levels of burnout and CF were experienced by 60% and 30% of respondents, respectively. Conclusions The prevalence of moderate burnout and CF symptoms in AEPs is comparable with other mental health professionals. Strategies to preserve psychological well-being such as enhancing mental health training for undergraduates and formalized supervision structures discussed.

Objective: The aim of this study was to understand the knowledge, beliefs, barriers, and behaviors of mental health professionals about physical activity and exercise for people with mental illness. Methods: The Portuguese version of The Exercise in Mental Illness Questionnaire was used to assess knowledge, beliefs, barriers, and behaviors about exercise prescription for people with mental illness in a sample of 73 mental health professionals (68.5% women, mean age = 37.0 years) from 10 Psychosocial Care Units (Centros de Atenção Psicossocial) in Porto Alegre and Canoas, state of Rio Grande do Sul, Brazil. Results: Most of respondents had received no formal training in exercise prescription. Exercise ranked fifth as the most important treatment, and most of the sample never or occasionally prescribed exercise. The most frequently reported barriers were lack of training in physical activity and exercise prescription and social stigma related to mental illness. Professionals who themselves met recommended physical activity levels found fewer barriers to prescribing physical activity and did so with greater frequency. Conclusion: Exercise is underrated and underused as a treatment. It is necessary to include physical activity and exercise training in mental health curricula. Physically active professionals are more likely to prescribe exercise and are less likely to encounter barriers to doing so. Interventions to increase physical activity levels among mental health professionals are necessary to decrease barriers to and increase the prescription of physical activity and exercise for mental health patients.

People with mental illness are twice as likely to develop cardiovascular, respiratory, infectious and metabolic diseases compared with the general population.1This disparity in health occurs from the earliest presentation of mental ill health and affects people across the life span,1 reducing life expectancy by 15–30 years compared with the general population.2 This poor physical health, as well as the associated widening mortality gap,3 has been described as a ‘human rights scandal’.2 This problem led to a Lancet Psychiatry Commission1 on protecting the physical health of people living with mental illness, with a focus on prevention and early intervention across all levels of treatment. The Lancet Psychiatry Commission outlines advances in our understanding of the link between physical and mental health, summarising findings from over 100 systematic reviews and meta-analyses, providing a practical blueprint towards protecting the physical health of this vulnerable population.1 Importantly, the blueprint recommends that all people living with mental illness have access to exercise and dietary interventions as part of routine mental healthcare. For people living with mental illness, higher rates of smoking, sleep disturbance, physical inactivity and …

Circumcisions are among the most commonly performed procedures in the pediatric population, but the value of the preputial skin often goes unrecognized as a potential graft (Ehrlichman et al., 2018). We highlight three patients who underwent coordinated circumcision and use of the excised preputial skin as a graft for syndactyly repair. Syndactyly, a condition where fingers are fused together, is often repaired utilizing skin from the groin region, which can result in unwanted hair growth and subcutaneous fat growth. The utilization of the prepuce is a convenient alternative that may have fewer undesirable qualities.

Background: Physical activity (PA) significantly improves physical health and clinical symptoms across mental disorders. Accredited Exercise Physiologists (AEPs) are trained to lead PA interventions for people with mental illness, but referrals to AEPs are low. Aims: To determine the knowledge and attitudes of delegates attending the 2017 Royal Australian and New Zealand College of Psychiatrists (RANZCP) conference toward physical health monitoring and exercise interventions for people with mental illness. Methods: A cross-sectional survey of RANZCP delegates investigated knowledge and attitudes toward PA for people with mental illness, self-reported PA, and their understanding of AEP’s role within mental health settings. A subgroup of delegates underwent fitness assessments. Results: Seventy-three delegates completed surveys and 24 underwent fitness assessments. Delegates demonstrated good knowledge regarding associations between PA and cardiovascular disease risk. Delegates were less knowledgeable of AEP’s role within mental health settings. Forty-six participants (63%) did not meet the Australian recommended guidelines for PA. No association between referrals to AEPs and self-reported PA or fitness measures were evident. Conclusions: Promoting PA participation for mental health professionals, coupled with education on the important role AEPs play in the multidisciplinary treatment of mental health consumers is vital to improve health outcomes for this vulnerable group.

Background: Exercise is a well-established treatment for depression, and its use in clinical care is supported by consumers and clinicians. However, whether public health messages regarding the benefits of exercise for depression have translated to public knowledge remains unknown. This study aims to examine the community's mental health literacy, and views regarding exercise delivery for people with depression. Methods: A vignette was presented as part of the telephone-based 2017 National Social Survey (n = 1,265). Interviewees identified what (if anything) was wrong with the person described, who they should seek help from, whether exercise might be beneficial, and how exercise should be delivered for the person described in the vignette. Results are reported using descriptive statistics. Results: From 1,265 respondents (response rate = 24%, n = 598 males, mean age 54.7 years [range 18–101]), almost two-thirds correctly identified the condition described in the vignette as depression. There was widespread support for seeking help from a general practitioner. Exercise was well supported in the treatment of the person described in the vignette, with general practitioners and accredited exercise physiologists highlighted as persons to consult regarding exercise. Views regarding the type of program were consistent with current best practice recommendations. Conclusions: Australian adults demonstrate a high level of exercise and mental health literacy. The high level of support for accredited exercise physiologists is evidence of the effectiveness of health promotion campaigns from peak exercise professional agencies.

Background Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. Objectives To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. Design/Methods In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the ‘Access’, ‘Acceptability’ and ‘Shared Decision Making’ dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. Results Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. Conclusions The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health care.

Adequate training loads promote favorable physical and physiological adaptations, reduce the likelihood of illness and injury, and, therefore, increase the possibility of success during competition. Our objective was to systematically examine the association between training load and performance outcomes in team sports. We systematically searched the PubMed, SPORTDiscus, and PsycINFO databases for original research published before July 2018. The search included terms relevant to training load, performance, and team sports. Articles were screened using pre-defined selection criteria, and methodological quality was assessed independently by two authors before data were extracted by the lead author. The electronic search yielded 5848 articles, 2373 of which were duplicates. A further 17 articles were retrieved from additional sources. In total, 26 articles met the inclusion criteria for this review, with quality scores ranging from 6 to 10 out of 11. Training exposure was more strongly associated with aerobic performance than other external training load measures. High-intensity activity (≥ 90% of maximum heart rate) was strongly associated with aerobic performance. The individualized training impulse model was strongly associated with aerobic performance, whereas various other training impulse models and perceptual training load measures showed weak associations with aerobic performance. There were no clear associations between training load and neuromuscular variables or game-related statistics. We found no consistent associations between external training load measures and performance. High-intensity internal training load appears to be the most prominent indicator of aerobic performance.

Scoliosis is a complication of fibrous dysplasia/McCune-Albright syndrome (FD/MAS); however, risk factors and long-term outcomes are unknown. Bisphosphonates are commonly used; however, it is unknown whether their use decrease the risk of progressive scoliosis. Clinical data from the National Institutes of Health (NIH) cohort study was reviewed. Cobb angles were measured, and variables associated with scoliosis progression were identified. Of 138 subjects with available radiographs, 84 (61%) had scoliosis, including 55 (65%) classified as mild (Cobb angle >10 to ≤30 degrees), 11 (13%) as moderate (>30 to ≤45 degrees), and 18 (22%) as severe (>45 degrees). Total skeletal disease burden was highly associated with scoliosis severity (p < 0.0001). Endocrinopathies associated with scoliosis included fibroblast growth factor 23 (FGF23)-mediated hypophosphatemia (p < 0.001) and hyperthyroidism (p < 0.001). Bone turnover markers, including osteocalcin and NTX-telopeptides, were associated with severe scoliosis (p < 0.01). Associations were identified between Cobb angle and functional metrics, including leg length discrepancy (p < 0.01), hip range of motion (p < 0.05), and strength of the gluteus medius and maximus (p < 0.01). Longitudinal analyses were conducted in 69 subjects who had serial radiographs over a median 4.9-year period (range, 0.9 to 14.7 years). Twenty-two subjects were treated with bisphosphonates; there was no difference in Cobb angle progression compared to untreated subjects (0.10 versus 0.53 degrees/year, p = 0.36). Longitudinal data was available for 10 of 12 subjects treated with spinal fusion; one had instrumentation failure, but in nine subjects Cobb angles were stable with 6.1 years of follow-up (range, 0.9 to 14.7 years). Two fatalities from scoliosis-associated restrictive lung disease occurred in subjects managed non-operatively. Scoliosis occurs frequently in patients with polyostotic FD, and may be potentially fatal. The primary risk factor for progressive scoliosis is total skeletal disease burden. Treatable features that contribute to scoliosis progression include leg length discrepancy, FGF23-mediated hypophosphatemia, and hyperthyroidism. Current data do not support routine use of bisphosphonates to prevent progression of spinal curvature. Spinal fusion is frequently effective in providing long-term stability, and may be lifesaving. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

Objective Glucose is the major energy substrate of the brain and crucial for normal brain function. In diabetes, the brain is subject to episodes of hypo- and hyperglycemia resulting in acute outcomes ranging from confusion to seizures, while chronic metabolic dysregulation puts patients at increased risk for depression and Alzheimer's disease. In the present study, we aimed to determine how glucose is metabolized in different regions of the brain using imaging mass spectrometry (IMS). Methods To examine the relative abundance of glucose and other metabolites in the brain, mouse brain sections were subjected to imaging mass spectrometry at a resolution of 100 μm. This was correlated with immunohistochemistry, qPCR, western blotting and enzyme assays of dissected brain regions to determine the relative contributions of the glycolytic and pentose phosphate pathways to regional glucose metabolism. Results In brain, there are significant regional differences in glucose metabolism, with low levels of hexose bisphosphate (a glycolytic intermediate) and high levels of the pentose phosphate pathway (PPP) enzyme glucose-6-phosphate dehydrogenase (G6PD) and PPP metabolite hexose phosphate in thalamus compared to cortex. The ratio of ATP to ADP is significantly higher in white matter tracts, such as corpus callosum, compared to less myelinated areas. While the brain is able to maintain normal ratios of hexose phosphate, hexose bisphosphate, ATP, and ADP during fasting, fasting causes a large increase in cortical and hippocampal lactate. Conclusion These data demonstrate the importance of direct measurement of metabolic intermediates to determine regional differences in brain glucose metabolism and illustrate the strength of imaging mass spectrometry for investigating the impact of changing metabolic states on brain function at a regional level with high resolution., Highlights • Utilization of glucose for glycolysis or the pentose phosphate pathway (PPP) is region-specific. • IMS allows simultaneous measurement of glucose metabolites across brain regions. • PPP is high in thalamus, while glycolysis predominates in cortex and amygdala. • Fasting induces changes in lactate distribution but not glucose metabolites or ATP.

This study aimed to establish the reliability of a novel netball task using a single-leg horizontal jump (SLHJ). Twenty-five females 18–39 years performed SLHJs for maximal displacement and ground-reaction forces. Participants completed two trials for each leg on two occasions separated by 6 weeks of pre-season netball training. Paired sample t tests highlighted no significant differences within trials for either limb. Significant (p ≤ .05) changes are reported for displacement, and dominant and nondominant X and Y forces, after 6-week netball training. SLHJ displacement showed excellent within-session reliability at baseline for dominant (intraclass correlation coefficient (ICC(2,1)) = 0.922, 95% confidence interval (CI) 0.826–0.966) and nondominant (ICC(2,1) = 0.925; 95% CI 0.832–0.967) landings. At 6 weeks, within-session reliability remained excellent for dominant (ICC(2,1) = 0.967, 95% CI 0.926–0.985) and nondominant ICC 0.968 (95% CI 0.929–0.986) landings. The reliability of the single-leg h...

Community awareness of mental illness is crucial for helping people access mental health support. The association between ability to recognise mental health disorders and lived experience is not well examined in Australian populations. Australian adults (n = 1265) provided responses to a vignette depicting a person with depression and self-reported a previous diagnosis of depression and/or anxiety. People who had lived experience with depression and/or anxiety had significantly higher levels of this aspect of mental health literacy than people without lived experience. Public mental health literacy promotion efforts should consider incorporating insights from people with lived experience of mental illness.

In fibrous dysplasia/McCune-Albright syndrome (FD/MAS), bone and bone marrow are, to varying degrees, replaced by fibro-osseous tissue typically devoid of hematopoietic marrow. Despite the extensive marrow replacement in severely affected patients, bone marrow failure is not commonly associated with FD/MAS. We present a 14-year-old girl with FD/MAS, who developed pancytopenia and extramedullary hematopoiesis (EMH) with no identified cause, in the setting of iatrogenic thyrotoxicosis and hyperparathyroidism. Pancytopenia, requiring monthly blood transfusions, persisted despite multiple strategies to correct these endocrinopathies. Due to worsening painful splenomegaly, likely as a result of sequestration, splenectomy was performed. Following splenectomy, pancytopenia resolved and patient has since been transfusion-independent. We report the first detailed case of bone marrow failure and EMH in FD/MAS. The etiology of marrow failure is likely multifactorial and related to the loss of marrow reserve due to extensive polyostotic FD, exacerbated by iatrogenic thyrotoxicosis and hyperparathyroidism. Mini Abstract: A patient with fibrous dysplasia developed bone marrow failure and extramedullary hematopoiesis. The etiology likely involved loss of hematopoetic marrow space and uncontrolled endocrinopathies. Splenectomy was therapeutic.

People diagnosed with mental illness (hereinafter "consumers") have higher rates of chronic disease and significantly shorter lives than the wider population. Peer workers have become increasingly involved in facilitating access to physical health care, yet the consumer perspective regarding peer involvement is unknown. This absent voice is needed to inform strategic planning and generate solutions to address the current inequity in health status.To articulate the views of consumers in regards to the potential use of peer workers to further the physical health of people with mental illness.A qualitative exploratory study was conducted involving four focus groups with 31 consumer participants. Focus group responses were analysed thematically.Three themes pertaining to enhancing physical health care emerged: (1) the potential of peer workers in mitigating existing barriers, (2) consumer advocacy organisations expanding their agenda and (3) benefits of segregated activities as a segue to mainstream options.The envisaged forms of peer contribution have far greater scope and depth than is currently considered in policy, the research literature and health practice. Innovative solutions are required for this neglected population. Individual and systemic advocacy led by peer workers can enhance access to physical health care and have the potential to reduce physical health inequalities.

Diabetic kidney disease (DKD) is one of the most common complications in diabetes mellitus and accounts for a large proportion of clinical nephrology practice. Studies have shown that the kallikrein-kinin system (KKS) may be involved in several pathogenic mechanisms that contribute to DKD, including oxidative stress, inflammatory cytokines, and profibrotic autacoids. This review focuses on recent research advance on the potential role of the KKS in the development of DKD and its clinical relevance.A number of recent studies support the idea that there is a protective role of the KKS in diabetes. For example, agents that activate the KKS have shown strong renal protective effects that might highlight its potential to change the clinical practice. In addition, diabetic mice lacking both bradykinin B2 and B1 receptors have worse kidney lesions as compared with wild-type diabetic mice.Current basic research has demonstrated that pharmacological activation of the KKS improves renal outcomes in diabetes. These findings suggest that this system may be a therapeutic target in preventing and treating DKD.

Central obesity is a risk factor for metabolic syndrome, but taking waist circumference measurements can be uncomfortable for psychiatric inpatient clinicians and consumers, and if often avoided. The objective of this study was to assess whether metabolic syndrome in people with mental illness can be diagnosed without using waist circumference measurements. This study involved a retrospective file audit of metabolic monitoring forms stored in consumers’ electronic health records of community-based and inpatient mental health consumers at a mental health service located in regional Queensland, Australia. Of the 721 consumer files audited, 261 included a metabolic monitoring form. Of these 261 forms, 74 contained data on all five criteria for metabolic syndrome and the population-specific criteria for waist circumference was met in 54 (73%) of cases. Metabolic syndrome was detected in 39 consumers and waist circumference was necessary for this diagnosis in 12 (31%) cases. Measurement of waist circumference is, therefore, necessary for the detection of metabolic syndrome for a substantial proportion of consumers. The common practice of avoiding waist circumference measurements clearly needs to change if the physical health needs of consumers are to be adequately addressed.

Accredited Exercise Physiologists (AEPs) are trained to deliver exercise and physical activity interventions for people with chronic and complex health conditions including those with mental illness. However, their views on exercise for mental illness, their exercise prescription practices, and need for further training are unknown.To examine the way in which Australian AEPs prescribe exercise for people with mental illness.Eighty-one AEPs (33.3 ± 10.4 years) completed an online version of the Exercise in Mental Illness Questionnaire. Findings are reported using descriptive statistics.AEPs report a high level of knowledge and confidence in prescribing exercise for people with mental illness. AEPs rate exercise to be at least of equal value to many established treatments for mental illness, and frequently prescribe exercise based on current best-practice principles. A need for additional training was identified. The response rate was low (2.4%) making generalisations from the findings difficult.Exercise prescription practices utilised by AEPs are consistent with current best-practice guidelines and there is frequent consultation with consumers to individualise exercise based on their preferences and available resources. Further training is deemed important.

Objectives: Evaluation of physical activity (PA) programs among populations with severe mental illness (SMI) has predominately focused on efficacy and therapeutic benefits. There is now strong evidence to support the benefits of PA in people with SMI. What remains is a gap in the implementation of pragmatic and sustainable PA interventions in mental-health settings. The current paper provides examples of interventions that have been successfully implemented in Australian settings, identifies key components of successful PA interventions and outlines practical strategies that can assist with widespread implementation of PA interventions in mental-health settings. Conclusions: There is an emergence of PA interventions being imbedded within a variety of mental-health settings. These interventions vary in terms of mode and intensity of service delivery. Yet, all aim to increase PA and reduce sedentary behaviour. Adopting the identified strategies may help facilitate successful implementation and increase access to PA interventions for mental-health service users.

Objectives Smartphone applications are increasingly used by researchers, coaches, athletes and clinicians. The aim of this study was to examine the concurrent validity and intra-rater reliability of the smartphone-based application, MyJump , against laboratory-based force plate measurements. Design Cross sectional study. Methods Participants completed counter-movement jumps (CMJ) (n=29) and 30cm drop jumps (DJ) (n=27) on a force plate which were simultaneously recorded using MyJump . To assess concurrent validity, jump height, derived from flight time acquired from each device, was compared for each jump type. Intra-rater reliability was determined by replicating data analysis of MyJump recordings on two occasions separated by seven days. Results CMJ and DJ heights derived from MyJump showed excellent agreement with the force plate (ICC values range from 0.991 for CMJ to 0.993) However mean DJ height from the force plate was significantly higher than MyJump (mean difference: 0.87cm, 95% CI: 0.69–1.04cm). Intra-rater reliability of MyJump for both CMJ and DJ was almost perfect (ICC values range from 0.997 for CMJ to 0.998 for DJ); however, mean CMJ and DJ jump height for Day 1 was significantly higher than Day 2 (CMJ: 0.43cm, 95% CI: 0.23–0.62cm); (DJ: 0.38cm, 95% CI: 0.23–0.53cm). Conclusion The present study finds MyJump to be a valid and highly reliable tool for researchers, coaches, athletes and clinicians; however, systematic bias should be considered when comparing MyJump outputs to other testing devices.

Diabetic nephropathy (DN) is a major cause of end-stage renal disease, and therapeutic options for preventing its progression are limited. To identify novel therapeutic strategies, we studied protective factors for DN using proteomics on glomeruli from individuals with extreme duration of diabetes (ł50 years) without DN and those with histologic signs of DN. Enzymes in the glycolytic, sorbitol, methylglyoxal and mitochondrial pathways were elevated in individuals without DN. In particular, pyruvate kinase M2 (PKM2) expression and activity were upregulated. Mechanistically, we showed that hyperglycemia and diabetes decreased PKM2 tetramer formation and activity by sulfenylation in mouse glomeruli and cultured podocytes. Pkm-knockdown immortalized mouse podocytes had higher levels of toxic glucose metabolites, mitochondrial dysfunction and apoptosis. Podocyte-specific Pkm2-knockout (KO) mice with diabetes developed worse albuminuria and glomerular pathology. Conversely, we found that pharmacological activation of PKM2 by a small-molecule PKM2 activator, TEPP-46, reversed hyperglycemia-induced elevation in toxic glucose metabolites and mitochondrial dysfunction, partially by increasing glycolytic flux and PGC-1α mRNA in cultured podocytes. In intervention studies using DBA2/J and Nos3 (eNos) KO mouse models of diabetes, TEPP-46 treatment reversed metabolic abnormalities, mitochondrial dysfunction and kidney pathology. Thus, PKM2 activation may protect against DN by increasing glucose metabolic flux, inhibiting the production of toxic glucose metabolites and inducing mitochondrial biogenesis to restore mitochondrial function.

Aims and Objectives: To elicit the perspectives of carers of people with mental illness regarding access to, and experience with, physical healthcare services for mental health consumers. Background: People diagnosed with mental illness have increased risks of physical illness and earlier death, problems able to be addressed through better physical health services. Carers of people with mental illness play a significant role in the mental healthcare system yet research examining their views is lacking. Design: Qualitative exploratory. Methods: In-depth interviews were conducted with 13 mental health carers. They were asked to describe their views and experiences pertaining to the physical health and availability of physical health care for the people they care for. Data were analysed using the framework of Braun and Clarke. Results: Analysis of carer responses identified two important themes: responsiveness and access, and a shortage of care coordination. Carers felt alienated from physical healthcare providers and were compelled to fill gaps in available care through persistence in ensuring access to physical healthcare services. Conclusions: The findings identify carers as key stakeholders in the physical health care for the people they care for. Their involvement in accessing and coordinating care provides vital perspective on health service capacity, which requires further consideration in the practice and research domains. Relevance to clinical practice: Carers of people diagnosed with mental illness are crucial to the effective delivery of mental health services. Their perspectives must be central to their research agenda and contribute to the development of initiatives to improve clinical practice and promote improved physical health care.

Background: People diagnosed with mental illness have shorter lives and poorer physical health, compared to the general population. These health inequities are usually viewed at an individual and clinical level, yet there is little research on the views of mental health consumers on clinical factors in broader contexts. Objective: To elicit the views of consumers of mental health services regarding their physical health and experiences of accessing physical health-care services. Design: Qualitative exploratory design involving focus groups. Setting and participants: The research was conducted in the Australian Capital Territory. Participants were consumers of mental health services. Main outcome measures: The Commission on Social Determinants of Health Framework was drawn on to lead deductive analysis of focus group interview transcripts. Results: Issues impacting consumers included poverty, the neglect of public services and being treated as second-class citizens because of diagnosis of mental illness and/or experiencing a psychosocial disability. These factors were connected with significant barriers in accessing physical health care, including the quality and relevance of health provider communication, especially when the broader contexts of mental health consumer's lives are not well understood. Discussion and conclusions: These findings suggest the Commission on Social Determinants of Health Framework could be utilized in research and policy, and may provide an effective platform for exploring better health communication with mental health consumers regarding this neglected health inequity.

Purpose of review Glucose 6-phosphate dehydrogenase (G6PD) is the rate-limiting enzyme of the pentose phosphate pathway. G6PD is the main source of the essential cellular reductant, NADPH. The purpose of this review is to describe the biochemistry of G6PD and NADPH, cellular factors that regulate G6PD, normal physiologic roles of G6PD, and the pathogenic role altered G6PD/NADPH plays in kidney disease. Recent findings NADPH is required for many essential cellular processes such as the antioxidant system, nitric oxide synthase, cytochrome p450 enzymes, and NADPH oxidase. Decreased G6PD activity and, as a result, decreased NADPH level have been associated with diabetic kidney disease, altered nitric oxide production, aldosterone-mediated endothelial dysfunction, and dialysis-associated anemia. Increased G6PD activity is associated with all cancers including kidney cancer. Inherited G6PD deficiency is the most common mutation in the world that is thought to be a relatively mild disorder primarily associated with anemia. Yet, intriguing studies have shown an increased prevalence of diabetes mellitus in G6PD-deficient people. It is not known if G6PD-deficient people are at more risk for other diseases. Summary Much more research needs to be done to determine the role of altered G6PD activity (inherited or acquired) in the pathogenesis of kidney disease.