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Impaired cognition is associated with lower quality of life and poor outcomes in schizophrenia. Brain glutamate may contribute to both clinical outcomes and cognition, but these relationships are not well-understood. We studied a multicentre cohort of 85 participants with non-affective psychosis using proton magnetic resonance spectroscopy. Glutamate neurometabolites were measured in the anterior cingulate cortex (ACC). Cognition was assessed using the Brief Assessment for Cognition in Schizophrenia (BACS). Patients were categorised as antipsychotic responders or non-responders based on treatment history and current symptom severity. Inverted U-shaped associations between glutamate or Glx (glutamate + glutamine) with BACS subscale and total scores were examined with regression analyses. We then tested for an interaction effect of the antipsychotic response group on the relationship between glutamate and cognition. ACC glutamate and Glx had a positive linear association with verbal memory after adjusting for age, sex and chlorpromazine equivalent dose (glutamate, β = 3.73, 95% CI = 1.26–6.20, P = 0.004; Glx, β = 3.38, 95% CI = 0.84–5.91, P = 0.01). This association did not differ between good and poor antipsychotic response groups. ACC glutamate was also positively associated with total BACS score (β = 3.12, 95% CI = 0.01–6.23, P = 0.046), but this was not significant after controlling for antipsychotic dose. Lower glutamatergic metabolites in the ACC were associated with worse verbal memory, and this relationship was independent of antipsychotic response. Further research on relationships between glutamate and cognition in antipsychotic responsive and non-responsive illness could aid the stratification of patient groups for targeted treatment interventions.

Background Currently, the acceptability and efficacy of pulmonary rehabilitation for adults with severe asthma is unknown. Objective To investigate the feasibility of performing a randomized controlled trial of asthma-tailored pulmonary rehabilitation (AT-PR) versus usual care (UC). Methods Adults with severe asthma were recruited and randomized 2:1 to AT-PR and UC. The primary outcomes were recruitment, retention, and serious adverse event rates. Secondary outcome measures included those for a future trial assessing the feasibility of collecting data. Assessments were performed at baseline, 12 weeks, and 9 months including measures of physical performance, health-related quality of life, and asthma control. A recruitment rate of 30% was estimated with 95% CI of ±7%, a retention rate of 75% ± 14% if we recruited 40 patients to AT-PR, and a serious adverse event rate of 2.5%. Results Sixty-one (26%) of 238 eligible patients were recruited (38 women; mean age, 54 ± 13 years; body mass index, 32 ± 7 kg/m2; FEV1, 1.9 ± 0.7 L; FEV1/forced vital capacity, 69% ± 11%). Fifty-one patients were randomized to AT-PR (n = 34) and UC (n = 17). The retention rate was 62% for the AT-PR group and 53% for the UC group, with a serious adverse event rate of 3.3% related to the study visits. Overall collection of the outcome measures was feasible. The results of the AT-PR group were suggestive of improvements in exercise performance, health-related quality of life, and asthma control, but the UC group results were either unchanged or worsened. Conclusions Both recruitment and retention rates were within the a priori estimated 95% CI. Our results indicate that AT-PR may be efficacious for adults with severe asthma but any future intervention and trial design would need further modifications to improve acceptability and retention rate.

Classification of gait in adults with hereditary spastic paresis is limited. Our aim was to use a previously established system to classify gait.Forty-nine participants were retrospectively recruited and grouped into existing classifications based on sagittal plane knee joint kinematic data extracted from a 3D analysis. Waveform analysis was used to compare the grouped data to determine if and where differences in the subjective classifications appeared.Classification of gait patterns in adults with hereditary spastic paresis is successful. Differences between groups in line with the classification system were confirmed by statistical analysis. Crouch gait is illustrated by a flexed knee throughout stance phase. Recurvatum gait is dominated by knee hyperextension in mid-late stance. Stiff-knee gait demonstrates limited knee range of motion in stance and jump-knee gait is characterised by less knee flexion in early and mid-stance phase than all groups. Sagittal plane hip and ankle kinematics compliment group differences at the knee joint. The jump-knee group is more flexed at the hip than all groups during loading response phase and mid-stance; and the recurvatum group is more extended at the hip than the crouch, jump-knee, and stiff-knee groups during mid and late-stance phase. There is less ankle dorsiflexion throughout stance phase in the recurvatum group than in all other groups.Sagittal plane knee joint kinematic data can be subjectively used to classify gait features in adults with hereditary spastic paresis. Novel analysis show hip and ankle sagittal plane kinematics can be used to further assist classification.

Alcohol use disorder is characterised by disrupted reward learning, underpinned by dysfunctional cortico-striatal reward pathways, although relatively little is known about the biology of reward processing in populations who engage in risky alcohol use. Cues that trigger reward anticipation can be categorized according to their learnt valence (i.e., positive vs. negative outcomes) and motivational salience (i.e., incentive vs. neutral cues). Separating EEG signals associated with these dimensions is challenging because of their inherent collinearity, but the recent application of machine learning methods to single EEG trials affords a solution. Here, the Alcohol Use Disorders Identification Test (AUDIT) was used to quantify risky alcohol use, with participants split into high alcohol (HA) (n = 22, mean AUDIT score: 13.82) and low alcohol (LA) (n = 22, mean AUDIT score: 5.77) groups. We applied machine learning multivariate single-trial classification to the electroencephalography (EEG) data collected during reward anticipation. The LA group demonstrated significant valence discrimination in the early stages of reward anticipation within the cue-P3 time window (400-550 ms), whereas the HA group was insensitive to valence within this time window. Notably, the LA, but not the HA group demonstrated a relationship between single-trial variability in the early valence component and reaction times for gain and loss trials. This study evidences disrupted hypoactive valence sensitivity in the HA group, revealing potential neurophysiological markers for risky drinking behaviours which place individuals at-risk of adverse health events.

Background70%–84% of individuals with antipsychotic treatment resistance show non-response from the first episode. Emerging cross-sectional evidence comparing cognitive profiles in treatment resistant schizophrenia to treatment-responsive schizophrenia has indicated that verbal memory and language functions may be more impaired in treatment resistance. We sought to confirm this finding by comparing cognitive performance between antipsychotic non-responders (NR) and responders (R) using a brief cognitive battery for schizophrenia, with a primary focus on verbal tasks compared against other measures of cognition.DesignCross-sectional.SettingThis cross-sectional study recruited antipsychotic treatment R and antipsychotic NR across four UK sites. Cognitive performance was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS).ParticipantsOne hundred and six participants aged 18–65 years with a diagnosis of schizophrenia or schizophreniform disorder were recruited according to their treatment response, with 52 NR and 54 R cases.OutcomesComposite and subscale scores of cognitive performance on the BACS. Group (R vs NR) differences in cognitive scores were investigated using univariable and multivariable linear regressions adjusted for age, gender and illness duration.ResultsUnivariable regression models observed no significant differences between R and NR groups on any measure of the BACS, including verbal memory (ß=−1.99, 95% CI −6.63 to 2.66, p=0.398) and verbal fluency (ß=1.23, 95% CI −2.46 to 4.91, p=0.510). This pattern of findings was consistent in multivariable models.ConclusionsThe lack of group difference in cognition in our sample is likely due to a lack of clinical distinction between our groups. Future investigations should aim to use machine learning methods using longitudinal first episode samples to identify responder subtypes within schizophrenia, and how cognitive factors may interact within this.Trail registration numberREC: 15/LO/0038.

To identify gait and balance measures that are responsive to change during the timeline of a clinical trial in Friedreich ataxia (FRDA), we administered a battery of potential measures three times over a 12-month period. Sixty-one ambulant individuals with FRDA underwent assessment of gait and balance at baseline, 6 months and 12 months. Outcomes included GAITRite® spatiotemporal gait parameters; Biodex Balance System Postural Stability Test (PST) and Limits of Stability; Berg Balance Scale (BBS); Timed 25-Foot Walk Test; Dynamic Gait Index (DGI); SenseWear MF Armband step and energy activity; and the Friedreich Ataxia Rating Scale Upright Stability Subscale (FARS USS). The standardised response mean (SRM) or correlation coefficients were reported as effect size indices for comparison of internal responsiveness. Internal responsiveness was also analysed in subgroups. SenseWear Armband daily step count had the largest effect size of all the variables over 6 months (SRM = -0.615), while the PST medial-lateral index had the largest effect size (SRM = 0.829) over 12 months. The FARS USS (SRM = 0.824) and BBS (SRM = -0.720) were the only outcomes able to detect change over 12 months in all subgroups. The DGI was the most responsive outcome in children, detecting a mean change of -2.59 (95% CI -3.52 to -1.66, p < 0.001, SRM = -1.429). In conclusion, the FARS USS and BBS are highly responsive and can detect change in a wide range of ambulant individuals with FRDA. However, therapeutic effects in children may be best measured by the DGI.

Background Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. Research question How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? Methods Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. Results Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer’s proposed intervention. Significance 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.

High-impact physical activity has a positive influence on bone health in humans. High-impact activity generates significant ground reaction forces (GRFs) between the plantar surface of the foot and the ground surface. However, the methods of assessment of plantar GRF are limited outside of a laboratory setting. We present a wearable device featuring force sensor resistors placed on the plantar surface of the foot which may present a feasible alternative to current laboratory technology. This paper presents the design, development, and validation of such a wearable system for the assessment of plantar GRF during various forms of physical activity. GRF estimates from the wearable device were moderately correlated with the gold-standard technology during physical activity, yet estimates during walking were highly variable. Future work should be directed toward individual anatomical site analysis to increase the accuracy of force estimates in a wider range of dynamic activities while also optimizing wearability of the system.

Biomechanical data in cerebral palsy are inherently variable but no optimal model of translational joint constraint has been identified. The primary aim of this study was to determine which model of translational joint constraint resulted in the lowest within-participant variability of lower limb joint angles and moments. The secondary aim was to determine which model best distinguished known functional groups in Cerebral Palsy.Three models (three degrees of freedom, six degrees of freedom and six degrees of freedom with specified joint translation constraint) were applied to data from running trials of 40 children with cerebral palsy.Joint angle standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model (p 0.050). For all joints in all planes of motion, joint moment standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model; standard deviations using the constrained model were smaller than the three degrees of freedom model by 10-30% of moment magnitude (0.01-0.03 Nm/kg; p 0.001). The six degrees of freedom models distinguished functional subgroups with larger effect size than the three degrees of freedom model only for hip power generation in swing.A model with specified joint constraint minimized within-participant variability during running and was useful for detecting differences in functional capacity in cerebral palsy.

ObjectiveTo identify gait and balance measures that are responsive to change during the timeline of a clinical trial in Friedreich ataxia (FRDA) we administered a battery of potential measures three times over a 12-month period.MethodsSixty-one ambulant individuals with FRDA underwent assessment of gait and balance at baseline, six months and 12 months. Outcomes included: GAITRite® spatiotemporal gait parameters; Biodex Balance System Postural Stability Test (PST) and Limits of Stability; Berg Balance Scale (BBS); Timed 25 Foot Walk Test; Dynamic Gait Index (DGI); SenseWear MF Armband step and energy activity; and the Friedreich Ataxia Rating Scale Upright Stability Subscale (FARS USS). The standardised response mean (SRM) or correlation coefficients were reported as effect size indices for comparison of internal responsiveness. Internal responsiveness was also analysed in subgroups.ResultsSenseWear Armband daily step count had the largest effect size of all the variables over six months (SRM=-0.615), while the PST medial-lateral index had the largest effect size (SRM=0.829) over 12 months. The FARS USS (SRM=0.824) and BBS (SRM=-0.720) were the only outcomes able to detect change over 12 months in all subgroups. The DGI was the most responsive outcome in children, detecting a mean change of −2.59 (95% CI −3.52 to −1.66, pConclusionsThe FARS USS and BBS are highly responsive and can detect change in a wide range of ambulant individuals with FRDA. However, therapeutic effects in children may be best measured by the DGI.

A neural network nonlinear regression algorithm is developed for retrieving ocean surface wind speed from the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) lidar measurements. The neural network is trained with CALIPSO ocean surface and atmospheric backscatter measurements together with collocated Advanced Microwave Scanning Radiometer for EOS (AMSR-E) ocean surface wind speed. Ocean surface wind speeds are derived by applying the neural network algorithm to CALIPSO measurements between 2008 and 2020. CALIPSO wind speed measurements of 2015 are also compared with Advanced Microwave Scanning Radiometer 2 (AMSR-2) measurements on the Global Change Observation Mission–Water “Shizuku” (GCOM-W) satellite. Aerosol optical depths are then derived from CALIPSO’s ocean surface backscatter signal and theoretical ocean surface reflectance calculated from CALIPSO wind speed and Cox-Munk wind–surface slope variance relation. This CALIPSO wind speed retrieval technique is an improvement from our previous studies, as it can be applied to most clear skies with optical depths up to 1.5 without making assumptions about aerosol lidar ratio.

Background Non adherence is common in difficult-to-control asthma, and can be identified using 7-day FeNO suppression testing where patients take additional fluticasone via Diskus™(Accuhaler) with an INCA™electronic monitoring device attached, and self-measure FeNO at home. However, this is inconvenient for patients attending a tertiary centre and limited by FeNO meter availability. It is not known if this approach alters clinical outcomes. Objectives and Methods To examine patient acceptability and the effectiveness of replacing usual combination inhaled corticosteroid (ICS)/long-acting b2-agonist (LABA) therapy with a fluticasone/salmeterol Diskus 500+INCA for 28 days, compared to the 7-day FeNO suppression test. Secondly, to explore the clinical outcomes of patients who have undertaken INCA monitoring. Results Twenty one of 23 subjects offered replacement of their usual ICS/LABA with fluticasone/salmeterol+ INCA accepted and completed 28 days of monitoring. Fourteen (66.6%) patients reduced their FeNO by >42% (FeNO suppressors), accompanied by improvements in FEV1, ACQ and blood eosinophils, similar to the 7-day test (n=74). At 1 year, 33.9% of FeNO suppressors progressed to treatment with a biologic therapy, compared to 72.7% of non suppressors (p=0.0005). FeNO suppressor patients taking maintenance prednisolone (n=13) reduced the median baseline dose from 10 mg to 3 mg, with further reductions limited by adrenal suppression. Conclusion Replacing existing inhaled therapy with fluticasone/salmeterol+INCA for at least 28 days is acceptable to the majority of patients with difficult-to-control asthma, and identifies prior medication non adherence. INCA monitoring coupled with clinical support potentially improves patient adherence and asthma control, and prevents unnecessary progression to biological therapy.

External feedback in the form of visual, auditory and tactile cues has been used to assist patients to overcome mobility challenges. However, these cues can become less effective over time. There is limited research on adapting cues to account for inter and intra-personal variations in cue responsiveness. We propose a cue-provision framework that consists of a gait performance monitoring algorithm and an adaptive cueing strategy to improve gait performance. The proposed approach learns a model of the person's response to cues using Gaussian Process regression. The model is then used within an on-line optimization algorithm to generate cues to improve gait performance. We conduct a study with healthy participants to evaluate the ability of the adaptive cueing strategy to influence human gait, and compare its effectiveness to two other cueing approaches: the standard fixed cue approach and a proportional cue approach. The results show that adaptive cueing is more effective in changing the person's gait state once the response model is learned compared to the other methods., 8 pages, 11 figures. It has been accepted to IEEE Robotics and Automation Letters (RA-L) 2021

The variability in the response to antipsychotic medication in schizophrenia may reflect between-patient differences in neurobiology. Recent cross-sectional neuroimaging studies suggest that a poorer therapeutic response is associated with relatively normal striatal dopamine synthesis capacity but elevated anterior cingulate cortex (ACC) glutamate levels. We sought to test whether these measures can differentiate patients with psychosis who are antipsychotic responsive from those who are antipsychotic nonresponsive in a multicenter cross-sectional study. 1H-magnetic resonance spectroscopy (1H-MRS) was used to measure glutamate levels (Glucorr) in the ACC and in the right striatum in 92 patients across 4 sites (48 responders [R] and 44 nonresponders [NR]). In 54 patients at 2 sites (25 R and 29 NR), we additionally acquired 3,4-dihydroxy-6-[18F]fluoro-l-phenylalanine (18F-DOPA) positron emission tomography (PET) to index striatal dopamine function (Kicer, min−1). The mean ACC Glucorr was higher in the NR than the R group after adjustment for age and sex (F1,80 = 4.27; P = .04). This was associated with an area under the curve for the group discrimination of 0.59. There were no group differences in striatal dopamine function or striatal Glucorr. The results provide partial further support for a role of ACC glutamate, but not striatal dopamine synthesis, in determining the nature of the response to antipsychotic medication. The low discriminative accuracy might be improved in groups with greater clinical separation or increased in future studies that focus on the antipsychotic response at an earlier stage of the disorder and integrate other candidate predictive biomarkers. Greater harmonization of multicenter PET and 1H-MRS may also improve sensitivity.

Background: In the UK, the criteria to withdraw mepolizumab therapy from patients with severe eosinophilic asthma include failure to achieve 50% reduction in exacerbation rate or a clinically important reduction in maintenance oral corticosteroids. Aim: To characterise the patients who failed to continue receiving mepolizumab Methods: Retrospective review of a clinical database and case notes for patients who received mepolizumab in Glenfield hospital, Leicester UK, between May 2017 to Feb 2020. Results: 21 out of a total 94 patients with severe eosinophilic asthma who received mepolizumab during the study period, had treatment stopped, the causes are listed in table 1. From the group considered to have failed mepolizumab therapy, 4/15 patients had underlying immunodeficiencies including common variable immune deficiency and specific antibody deficiency that required regular immunoglobulin therapy, 2/15 with bronchiectasis and recurrent bronchitis initiating prophylaxis Azithromycin therapy and 3/15 patients who requested treatment withdrawal due to lack of perceived benefits. The remaining 6/15 patients were deemed by the MDT to have failed mepolizumab therapy without a defined cause. Conclusion: Treatment failure with mepolizumab may be secondary to exacerbation events that are driven by infection, necessitating the need to characterise exacerbations carefully prior to initiating type-2 monoclonals in severe asthma.

Introduction Osteoporosis and bone fractures are common in chronic obstructive pulmonary disease (COPD) and contribute significantly to morbidity and mortality. Current national guidance on COPD management recommends addressing bone health in patients, however, does not detail how. This consensus outlines key elements of a structured approach to managing bone health and fracture risk in patients with COPD. Methods A systematic approach incorporating multifaceted methodologies included detailed patient and healthcare professional (HCP) surveys followed by a roundtable meeting to reach a consensus on what a pathway would look like. Results The surveys revealed that fracture risk was not always assessed despite being recognised as an important aspect of COPD management by HCPs. The majority of the patients also stated they would be receptive to discussing treatment options if found to be at risk of osteoporotic fractures. Limited time and resource allocation were identified as barriers to addressing bone health during consultations. The consensus from the roundtable meeting was that a proactive systematic approach to assessing bone health should be adopted. This should involve using fracture risk assessment tools to identify individuals at risk, investigating secondary causes of osteoporosis if a diagnosis is made and reinforcing non-pharmacological and preventative measures such as smoking cessation, keeping active and pharmacological management of osteoporosis and medicines management of corticosteroid use. Practically, prioritising patients with important additional risk factors, such as previous fragility fractures, older age and long-term oral corticosteroid use for an assessment, was felt required. Conclusion There is a need for integrating fracture risk assessment into the COPD pathway. Developing a systematic and holistic approach to addressing bone health is key to achieving this. In tandem, opportunities to disseminate the information and educational resources are also required., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/sVZiOpxNcBE

A high proportion of children with Attention Deficit Hyperactivity Disorder- Combined type (ADHD-CT) experience sleep and motor problems. This study investigated (a) whether motor proficiency moderated the relationship between ADHD symptoms and sleep problems in children with and without ADHD-CT and (b) whether this moderation differed as a function of ADHD diagnosis.A sample of 70 primary school male children between 8-15 years were recruited; children with ADHD-CT (n = 38; mean age 10 years, 2 months [SD = 1 year, 6 months]) and a typically developing (TD) (n = 32; mean age 9 years, 6 months [SD = 1 year, 5 months]) group.Motor proficiency was measured using the Movement Assessment Battery for Children-2nd Edition (MABC-2), ADHD symptoms were measured using the Conners' Parent Rating Scale (CPRS) and parent reported sleep problems were measured using the Children's Sleep Habits Questionnaire (CSHQ).Children who reported higher ADHD symptoms and lower motor proficiency scores reported more sleep problems. The moderation effect only held in children with a diagnosis of ADHD-CT and not in the typically developing group.These findings indicate that children who experience greater severity of ADHD symptoms who also have lower motor proficiency may be at increased risk of experiencing sleep problems. These findings also illustrate the importance of considering motor proficiency when exploring risk factors for sleep problems in children with ADHD-CT as well as sleep interventions.

Cerebellar ataxia often results in impairment in ambulation secondary to gait pattern dysfunction and compensatory gait adjustments. Pharmaceutical and therapy-based interventions with potential benefit for gait in ataxia are starting to emerge, however evaluation of such interventions is hampered by the lack of outcome measures that are responsive, valid and reliable for measurement of gait decline in cerebellar ataxia. This systematic review aimed for the first time to evaluate the psychometric properties of gait and walking outcomes applicable to individuals with cerebellar ataxia. Only studies evaluating straight walking were included. A comprehensive search of three databases (MEDLINE, CINAHL and EMBASE) identified 53 studies meeting inclusion criteria. Forty-nine were rated as 'poor' as assessed by the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The primary objective of most studies was to explore changes in gait related to ataxia, rather than to examine psychometric properties of outcomes. This resulted in methodologies not specific for psychometric assessment. Thirty-nine studies examined validity, 11 examined responsiveness and 12 measured reliability. Review of the data identified double and single support and swing percentage of the gait cycle, velocity, step length and the Scale for Assessment and Rating of Ataxia (SARA) gait item as the most valid and responsive measures of gait in cerebellar ataxia. However, further evaluation to establish their reliability and applicability for use in clinical trials is clearly warranted. We recommend that inter-session reliability of gait outcomes should be evaluated to ensure changes are reflective of intervention effectiveness in cerebellar ataxia.

The role of clinical nurse specialists (CNSs) in interstitial lung disease (ILD) is evolving in response to clinical guidelines and the growth of clinical research. The role is well established in the UK, although more ILD posts are needed to ensure supply meets clinical demand. This phenomenon is also happening across Europe. An appreciation of the similarities and differences between CNS and advanced nurse practitioners is important given the challenges in defining, developing and supporting this nursing specialisation. Globally, different models exist. In some countries charitable organisations take a leading role in supporting patients. Many European centres look to the National Institute for Health and Care Excellence guidelines and quality standards as a template to develop and evaluate the role of the ILD CNS. We present a UK perspective in the context of a government subsidised healthcare system to promote professional discussion and debate regarding the future of nursing practice in the ILD specialty. Key points ILDs are often complex and associated with significant mortality, morbidity and co-morbid conditions that require a technical healthcare skill set There is worldwide shortage of nurses, low retention rates and retirement of many skilled nurses Collaboration across the ILD interdisciplinary community is needed to safeguard the future of our professions and high-quality patient care The ILD interdisciplinary and nurse network has identified key priorities to help secure the future of the ILD clinical and academic nurse specialism Educational aims To explain the similarities and differences between clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs) in the context of ILD specialism To review contemporary nursing specialism in the UK’s government subsidised healthcare system To stimulate discussion and debate across the European/international respiratory community regarding the clinical and academic development of the ILD CNS To identify key priorities that will support collaboration across the ILD interdisciplinary workforce in clinical practice and research, Specialist nurses and interdisciplinary healthcare professionals are fundamental to the care of patients diagnosed with ILD. ILD specific clinical and academic standards are needed to sustain and develop a dedicated ILD workforce http://ow.ly/toee30h1UkW

Many oil paintings, dating from the 15th century to the present, are affected by the formation of heavy-metal carboxylates (soaps) that alter the structural integrity and appearance of the works. Through transport phenomena not yet understood, free fatty acids formed from oils used as binders migrate through the paint film and react with heavy-metal ions that are constituents of pigments and/or driers, forming metal carboxylates. The local molecular dynamics of fatty acids and metal carboxylates are factors influencing material transport in these systems. We report temperature-dependent 2H NMR spectra of palmitic acid and lead palmitate as pure materials, in cross-linked linseed oil films, and in a lead white linseed oil paint film as part of our broader research into metal soap formation. Local dynamics at the α carbon, at the terminal methyl group, and at the middle of the fatty acid chain were observed in specifically deuterated materials. Changes in the dynamic behavior with temperature were observed by the appearance of two species, a solid-like material and a liquid-like material. The relative amounts of the two phases and their deuterium NMR parameters indicate that the amount of liquid-like material and the local dynamics at that site increase with temperature. At the three locations along the chain and at all temperatures, there is a larger percentage of acyl chains of both palmitic acid and lead palmitate that are "mobile" or liquid-like in linseed oil films than there are in the pure materials. However, the percentage of liquid-like species is decreased in a lead white paint film, as compared to a linseed oil matrix. In addition, these experiments indicate that there is a larger percentage of liquid-like acyl chains of palmitic acid than of lead palmitate under identical conditions in these model paint systems.

Background Older adults seek health-related information through casual internet searches. Yet, researchers focus on peer-reviewed journals and conference presentations as primary dissemination strategies. Representatives of mass media are alerted (passive diffusion) of new studies or recommendations, but the veracity of the information shared is not often analyzed, and when it is, the analysis is often not comprehensive. However, most older adults do not have access to peer-reviewed journal articles or paid subscription services for more reputable media outlets. Objective We aimed to determine what information was readily available (ie, open access) to older adults who may casually search the internet for physical activity recommendations. Methods We performed a 6-part scoping review to determine the research question and available evidence, and extract data within open-access top hits using popular online search engines. Results were categorized by a dissemination model that has categories of sources, channels, audience, and messages. Results After the iterative search process, 92 unique articles were included and coded. Only 5 (5%) cited physical activity guidelines, and most were coded as promoting healthy aging (82/92, 89%) and positive framing (84/92, 91%). Most articles were posed as educational, but the authors’ credentials were rarely reported (ie, 22% of the time). Muscle strengthening and balance components of the physical activity guidelines for older adults were rarely reported (72/92, 78% and 80/92, 87%, respectively) or inaccurately reported (3/92, 3% and 3/92, 3%, respectively). Conclusions Inconsistent messages lead to mistrust of science and public health representatives. This work highlights the lack of evidence within existing open-access resources. Further efforts are needed to ensure evidence-based public health messages are in the sources and channels older adults are using to inform their knowledge and behaviors.