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Casey L Peiris,1 Amy Gallagher,2 Nicholas F Taylor,1,3 Sionnadh McLean2 1School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; 2Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK; 3Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, AustraliaCorrespondence: Sionnadh McLean, Collegiate Campus, Sheffield Hallam University, L108, 36 Collegiate Crescent, Sheffield, S10 2BP, UK, Tel +447342 092 340, Email S.McLean@shu.ac.ukBackground: Exercise and physical activity interventions improve short-term outcomes for people with metabolic syndrome, but long-term improvements are reliant on sustained adherence to lifestyle change for effective management of the syndrome. Effective ways of improving adherence to physical activity and exercise recommendations in this population are unknown. This systematic review aims to determine which interventions enhance adherence to physical activity and/or exercise recommendations for people with metabolic syndrome.Methods: Electronic databases MEDLINE, PubMed, CINAHL, SPORTdiscuss and ProQuest were searched to July 2022. Risk of bias was assessed using the Cochrane risk of bias tool and overall certainty of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation approach.Results: Four randomized controlled trials with 428 participants (mean age 49– 61 years) were included. There was very low certainty evidence from two trials that goal setting interventions may improve adherence to physical activity recommendations over three to six months. There was low certainty evidence from two trials that self-monitoring and feedback interventions increased adherence to physical activity interventions over 12 months for people with metabolic syndrome.Conclusion: Clinicians and researchers may consider using behavior change strategies such as goal setting, monitoring and feedback in interventions for people with metabolic syndrome to increase adherence to physical activity and exercise recommendations over 3 to 12 months, but high-quality evidence is lacking.Keywords: metabolic syndrome, adherence, long-term condition, behavior change, physical activity, exercise

Laila El Haddad,1 Casey L Peiris,2 Nicholas F Taylor,2,3 Sionnadh McLean1 1Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK; 2School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; 3Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, AustraliaCorrespondence: Sionnadh McLean, Collegiate Campus, Sheffield Hallam University, L108, 36 Collegiate Crescent, Sheffield, S10 2BP, UK, Tel +447342 092 340, Email S.McLean@shu.ac.ukBackground: Long-term adherence to exercise or physical activity (EPA) is necessary for effective first-line management of metabolic syndrome (MetS). Little is known about the determinants of adherence in this population. This systematic review aims to identify the determinants of adherence to EPA in people with MetS.Methods: Six databases (MEDLINE, CINAHL Complete, PubMed, PsycINFO, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies published before April 26, 2021. Primary research studies investigating factors affecting EPA adherence in adults with MetS in outpatient settings were included. Risk of bias was assessed using the QUIPS (Quality in Prognostic Factor Studies) and CASP (Critical Appraisal Skills Program) tools, for quantitative and qualitative methodologies, respectively.Results: Four quantitative studies (n = 766) and one qualitative (n = 21) study were included in the review, evaluating 34 determinants of adherence to EPA in MetS. Limited evidence was found for an association between ten determinants and non-adherence to EPA: lower self-rated health, lower baseline EPA, lower high-density lipoprotein cholesterol (HDL-C), fewer walk-friendly routes within 1 km, less consciousness raising, lower self-re-evaluation, lower self-liberation, reporting more arguments against EPA (cons), lower social support, and fewer positive psychological constructs. There was limited evidence of no association or conflicting evidence for the remaining 24 determinants.Conclusion: A small number of included studies, most of low methodological quality, resulted in limited confidence in the findings for all determinants. The identified determinants associated with non-adherence are all potentially modifiable, thus further high-quality studies are required to increase confidence in the determinants of EPA in people with MetS, and test interventions.Keywords: adherence, long-term condition, behavior change

Abstract Background Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service. Methods/Design A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial. Discussion This paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services. Clinical trial registration number Australian and New Zealand Clinical Trials Registry ACTRN12609000973213

Objectives: Grit, resilience and a growth-mindset influence students' ability to positively adapt to the challenges of health professional training. However, it is unclear if interventions can improve these traits. This systematic review aimed to explore if interventions can improve these traits in health professional students (primary) and their impact on academic and/or wellbeing outcomes (secondary)., Methods: A comprehensive search of CINAHL, MEDLINE, Eric and Embase was conducted from inception until 15 March 2023. Randomised or non-randomised controlled trials and single-group intervention studies that aimed to improve health professional students' resilience, grit and/or growth-mindset were eligible for inclusion. Two reviewers independently screened studies for inclusion and evaluated quality using the Mixed Methods Appraisal Tool. Post-intervention data from randomised and non-randomised control trials were pooled using a random-effects model to calculate standardised mean differences (SMD) and 95% confidence intervals (CIs)., Results: Resilience interventions improved resilience by a moderate amount in 13 studies with 990 participants (pooled SMD 0.74, 95%CI 0.03 to 1.46) and a large amount when interventions were greater than one session duration in 10 trials with 740 participants (pooled SMD 0.97, 95%CI 0.08 to 1.85). Grit and growth-mindset interventions improved grit (pooled SMD 0.48, 95%CI -0.05 to 1.00, n = 2) and growth-mindset (pooled SMD 0.25, 95%CI -0.18 to 0.68, n = 2) by a small amount. Resilience interventions decreased perceived stress by a small amount (pooled SMD -0.38, 95%CI -0.62 to -0.14, n = 5)., Conclusions: Resilience interventions improve resilience and decrease perceived stress in health professional students. Preliminary evidence suggests grit and growth-mindset interventions may also benefit health professional students. Interventions may be most effective when they are longer than one session and targeted to students with low baseline levels of resilience and grit., (© 2024 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objectives: To study if early initiation of inhaled beclomethasone 1200 mcg in patients with asymptomatic, mild or moderate COVID-19 reduces disease progression to severe COVID-19., Design: Double-blinded, parallel-groups, randomised, placebo-controlled trial., Setting: A hospital-based study in Sri Lanka., Participants: Adults with asymptomatic, mild or moderate COVID-19, presenting within the first 7 days of symptom onset or laboratory diagnosis of COVID-19, admitted to a COVID-19 intermediate treatment centre in Sri Lanka between July and November 2021., Interventions: All participants received inhaled beclomethasone 600 mcg or placebo two times per day, for 10 days from onset of symptoms/COVID-19 test becoming positive if asymptomatic or until reaching primary endpoint, whichever is earlier., Primary Outcome Measure: Progression of asymptomatic, mild or moderate COVID-19 to severe COVID-19., Secondary Outcome Measures: The number of days with a temperature of 38°C or more and the time to self-reported clinical recovery., Results: A total of 385 participants were randomised to receive beclomethasone(n=193) or placebo(n=192) stratified by age (≤60 or >60 years) and sex. One participant from each arm withdrew from the study. All participants were included in final analysis. Primary outcome occurred in 24 participants in the beclomethasone group and 26 participants in the placebo group (RR 0.90 ; p=0.763). The median time for self-reported clinical recovery in all participants was 5 days (95% CI 3 to 7) in the beclomethasone group and 5 days (95% CI 3 to 8) in the placebo group (p=0.5). The median time for self-reported clinical recovery in patients with moderate COVID-19 was 5 days (95% CI 3 to 7) in the beclomethasone group and 6 days (95% CI 4 to 9) in the placebo group (p=0.05). There were no adverse events., Conclusions: Early initiation of inhaled beclomethasone in patients with asymptomatic, mild or moderate COVID-19 did not reduce disease progression to severe COVID-19., Trial Registration Number: Sri Lanka Clinical Trials Registry; SLCTR/2021/017., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome., Materials and Methods: A cross-sectional, multi-centre, observational study of adults ( n  = 193) presenting to rehabilitation with various health complaints. Metabolic syndrome was determined according to the International Diabetes Federation joint consensus worldwide definition. Health literacy was assessed using the Rapid Estimate of Adult literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Physical activity was assessed using accelerometers and dietary intake was assessed using a food frequency questionnaire., Results: One hundred and twenty three participants (64%) had metabolic syndrome. Of these, only three (2%) knew they had it. People with metabolic syndrome scored lower on health literacy (S-TOFHLA MD -2.10, 95% confidence interval (CI) -3.98 to -0.22) and took 1311 (95%CI 375 to 2246) fewer daily steps than those without metabolic syndrome. There were no differences in dietary intake., Conclusions: Metabolic syndrome is a prevalent and under-recognised condition in community rehabilitation. Community healthcare professionals and health services may need to consider a broader approach to management including lifestyle assessment and intervention of patients with various conditions. Implications for rehabilitationAlmost two-thirds of adults in community rehabilitation had underlying, undetected metabolic syndrome.Adults with metabolic syndrome completed less objectively measured physical activity and had lower health literacy levels than those without metabolic syndrome.A broader approach to management may need to be considered in community rehabilitation where patients presenting for rehabilitation of various conditions would likely benefit from lifestyle assessment and intervention.

Electric fields can induce bond breaking and bond forming, catalyze chemical reactions on surfaces, and change the structure of self-assembled monolayers on electrode surfaces. Here, we study the effect of electric fields supplied either by an electrochemical potential or by conducting atomic force microscopy (C-AFM) on Si-based monolayers. We report that typical monolayers on silicon undergo partial desorption followed by the oxidation of the underneath silicon at +1.5 V vs Ag/AgCl. The monolayer loses 28% of its surface coverage and 55% of its electron transfer rate constant ( k ) when +1.5 V electrochemical potential is applied on the Si surface for 10 min. Similarly, a bias voltage of +5 V applied by C-AFM induces complete desorption of the monolayer at specific sites accompanied by an average oxide growth of 2.6 nm when the duration of the bias applied is 8 min. Current-voltage plots progressively change from rectifying, typical of metal-semiconductor junctions, to insulating as the oxide grows. These results define the stability of Si-based organic monolayers toward electric fields and have implication in the design of silicon-based monolayers, molecular electronics devices, and on the interpretation of charge-transfer kinetics across them.et ) when +1.5 V electrochemical potential is applied on the Si surface for 10 min. Similarly, a bias voltage of +5 V applied by C-AFM induces complete desorption of the monolayer at specific sites accompanied by an average oxide growth of 2.6 nm when the duration of the bias applied is 8 min. Current-voltage plots progressively change from rectifying, typical of metal-semiconductor junctions, to insulating as the oxide grows. These results define the stability of Si-based organic monolayers toward electric fields and have implication in the design of silicon-based monolayers, molecular electronics devices, and on the interpretation of charge-transfer kinetics across them.

Biochar has widely been utilized as an agricultural soil amendment owing to its enhanced surface properties and cost-effectiveness. In the present work, the influence of tea waste biochar (TWBC) upon acid modification on Allium cepa L. (red onion) growth has been studied. Its effect as a soil amendment has also been studied by assessing the nutrient retention, microbial population growth and immobilization of potentially toxic metal ions. A greenhouse experiment was carried out by applying different biochar (BC) ratios (2% and 5% w/w) to soil as the growth media for onion plants. A 2.4 times (2.4 × ) reduction of phosphate from leaching was observed upon BC application at a ratio of 2% than that of 5%. Moreover, red onion plants that grew in the BC-fertilizer amended soil at a 2% ratio showed higher growth compared to that of 5%. A ∼1.3 × and ∼1.2 × increment of total dry weight was observed upon amendment of soil fertilizer system with nitric and sulfuric acid-modified TWBC, respectively. An analysis of the potentially toxic metal ion uptake by the respective plant parts showed that lead uptake by the roots of red onion was ∼8.3 × less in BC amended soil compared to that in contaminated soil. Thus, acid-modified TWBC can be considered a potential soil amendment for an enhanced red onion growth. Employing TWBC as a soil amendment in tropical countries, where tea-waste is in abundance, will boost sustainable agriculture., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To explore entry-level physiotherapy students' attitudes and beliefs relating to weight bias and stigmatisation in healthcare., Design: Cross sectional survey of physiotherapy students., Methods: All final year physiotherapy students (n = 215) enrolled in entry-level physiotherapy programmes in the Republic of Ireland were invited to participate. Each received a questionnaire, consisting of 72 questions, within four key sections. Descriptive statistics and frequencies were used to analyse the data., Results: A response rate of 83% (179/215) was achieved. Whilst physiotherapy students, overall, had a positive attitude towards people with obesity, 29% had a negative attitude towards people with obesity, 24% had a negative attitude towards managing this population and most (74%) believed obesity was caused by behavioural and individual factors. Over one third of students (35%) reported that they would not be confident in managing patients with obesity and more than half (54%) felt treating patients with obesity was not worthwhile., Conclusion: This study provides preliminary findings to suggest that weight stigma-reduction efforts are warranted for physiotherapy students. Helping students to understand that obesity is a complex, chronic condition with multiple aspects requiring a multi-faceted approach to its management might be the first step towards dispelling these negative attitudes towards patients living with obesity. Inclusion of a formal obesity curriculum should perhaps now be part of the contemporary physiotherapy students' education., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Alongside glucose lowering therapy, clinical guidelines recommend lifestyle interventions as cornerstone in the care of people living with type 2 diabetes (T2DM). There is a specific need for an up-to-date review assessing the effectiveness of lifestyle interventions for people with T2DM living in low-and-middle income countries (MICs). Four electronic databases were searched for RCTs published between 1990 and 2020. T2DM, lifestyle interventions, LMICs and their synonyms were used as search terms. Data codebooks were developed and data were extracted. Narrative synthesis and meta-analysis were conducted using random effects models to calculate mean differences (MD) and standardized mean differences (SMD) and 95% confidence intervals (CI). Of 1284 articles identified, 30 RCTs ( n = 16,670 participants) met the inclusion criteria. Pooled analysis revealed significant improvement in HBA1c (MD -0.63; CI: -0.86, -0.40), FBG (SMD -0.35; CI: -0.54, -0.16) and BMI (MD -0.5; CI: -0.8, -0.2). In terms of intervention characteristics, those that included promoted self-management using multiple education components (e.g., diet, physical activity, medication adherence, smoking cessation) and were delivered by healthcare professionals in a hospital/clinic setting were deemed most effective. However, when interpreting these results, it is important to consider that most included studies were evaluated as being of low quality and there was a significant amount of intervention characteristics heterogeneity. There is a need for further well-designed studies to inform the evidence base on which lifestyle interventions are most effective for glycemic control in adults with T2DM living in LMICs.

Despite the high prevalence of self-harm among young people, as well as their extensive use of mobile apps for seeking support with their mental healthcare, it is unclear whether the design of mobile apps aimed at targeting self-harm is underpinned by behavior change techniques (BCTs). To systematically analyze and identify (a) what BCTs and (b) what theories are present in self-harm apps for young people in an attempt to understand their active components. Systematic searches in Apple store, followed by thorough screening, were conducted to identify free mobile apps targeting self-harm in young people. Five apps met the inclusion criteria and were used by trained researchers, who coded identified features against the BCT Taxonomy V1. Despite the majority of apps being underpinned by principles of Dialectical Behavior Therapy (DBT), no other information is available about specific theories underpinning these apps. Nineteen of the 93 BCTs were identified across the five apps. The most frequently used BCT was "Distraction" (54.2%), offering ideas for activities to distract users from self-harming. Other techniques that were used often were "Social Support (unspecified)" (27.0%) and "Behavior Substitution" (10.6%). This study provides the first analysis of BCTs present in mental health apps which are designed to target the reduction of self-harm in young people. Future research is needed to evaluate the effectiveness of the apps, as well as assess the effectiveness of the BCTs present., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To systematically review the effect of core stability exercises in addition to usual care physiotherapy on patient outcomes after stroke., Data Sources: Cumulative Index to Nursing and Allied Health, MEDLINE, Physiotherapy Evidence Database (PEDro), PubMed, and EMBASE were searched to November 2018., Study Selection: Eleven randomized controlled trials that compared usual care physiotherapy with usual care physiotherapy with additional core stability exercises in people with stroke were included. The initial search yielded 1876 studies., Data Extraction: Two independent reviewers applied inclusion and exclusion criteria and extracted data on methodological quality using the PEDro scale, participant characteristics, intervention details, outcome measures, and results., Data Synthesis: Postintervention means and SDs were pooled to calculate either the standardized mean difference (SMD) or the mean difference (MD) and 95% CIs using a random-effects model and inverse variance methods. There was moderate quality evidence to suggest the addition of core stability exercises to usual care physiotherapy improved trunk control (SMD, 0.94; 95% CI, 0.44-1.44; I 2 =69%), functional dynamic balance (SMD, 1.23; 95% CI, 0.5-1.97; I 2 =71%), and walking speed (MD, 0.27m/s; 95% CI, 0.01-0.52; I 2 =40%) in people with acute and chronic stroke. No significant effect was found when assessing functional ambulation categories or the timed Up and Go test, and mixed results were found for global functioning., Conclusions: The addition of core stability exercises to usual care physiotherapy after stroke may lead to improved trunk control and dynamic balance. Therefore, core stability exercises should be included in rehabilitation if improvements in these domains will help clients achieve their goals. Future trials should consider incorporating outcomes of body kinematics during functional tasks to assess movement quality and assess participation outcomes., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Remediation of steroidal estrogens from aqueous ecosystems is of prevailing concern due to their potential impact on organisms even at trace concentrations. Biochar (BC) is capable of estrogen removal due to its rich porosity and surface functionality. The presented review emphasizes on the adsorption mechanisms, isotherms, kinetics, ionic strength and the effect of matrix components associated with the removal of steroidal estrogens. The dominant sorption mechanisms reported for estrogen were π-π electron donor-acceptor interactions and hydrogen bonding. Natural organic matter and ionic species were seen to influence the hydrophobicity of the estrogen in multiple ways. Zinc activation and magnetization of the BC increased the surface area and surface functionalities leading to high adsorption capacities. The contribution by persistent free radicals and the arene network of BC have promoted the catalytic degradation of adsorbates via electron transfer mechanisms. The presence of surface functional groups and the redox activity of BC facilitates the bacterial degradation of estrogens. The sorptive removal of estrogens from aqueous systems has been minimally reviewed as a part of a collective evaluation of micropollutants. However, to the best of our knowledge, a critique focusing specifically and comprehensively on BC-based removal of steroidal estrogens does not exist. The presented review is a critical assessment of the existing literature on BC based steroidal estrogen adsorption and attempts to converge the scattered knowledge regarding its mechanistic interpretations. Sorption studies using natural water matrices containing residue level concentrations, and dynamic sorption experiments can be identified as future research directions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Digestion of biomass derived carbonaceous materials such as biochar (BC) can be challenging due to their high chemical recalcitrance and vast variations in composition. Reports on the development of specific sample digestion methods for such materials remain inadequate and thus require considerable attention. Nine different carbonaceous materials; slow-pyrolyzed tea-waste and king coconut BC produced at 300 °C, 500 °C and 700 °C, sludge waste BC produced at 700 °C, wet fast-pyrolyzed Douglas-Fir BC and steam activated coconut shell BC have been tested to evaluate a relatively fast and convenient open-vessel digestion method using seven digestion reagents including nitric acid (NA), fuming nitric acid (FNA), sulfuric acid (SA), NA/SA, FNA/SA, NA/H 2 O 2 and SA/H 2 O 2 mixtures. From the tested digestion reagents, SA/H 2 O 2 mixture dissolved low temperature produced BC (LTBC) within 2 h with occasional shaking and no external heating. Except peroxide mixtures, the other reagents were used to evaluate microwave digestion (MWD) efficiency. Nitric acid mixture was capable of only completely digesting LTBC in the MWD procedure whereas FNA, NA/SA and FNA/SA mixtures resulted in the successful dissolution of all tested carbonaceous materials. Amongst them, FNA provided the least matrix effect in the quantification of the four metals tested using flame atomic absorption spectrophotometry. Tested recoveries for FNA were satisfactory as well. It was concluded that FNA is a preferable reagent for microwave digestion of BC., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Metabolic syndrome is characterised by a clustering of metabolic risk factors including abdominal obesity, raised triglycerides, lowered HDL cholesterol, hypertension and impaired glucose tolerance. Multifaceted lifestyle interventions including diet and exercise are recommended as the first-line treatment for the metabolic syndrome., Objective: To investigate the effects of lifestyle interventions that include both diet interventions and supervised exercise on outcomes for people with metabolic syndrome., Methods: A systematic review and meta-regression was conducted. PubMed, EMBASE, MEDLINE and CINAHL were searched from the earliest date possible until November 2018 to identify randomised controlled trials examining the effects of lifestyle interventions compared to usual care on patient health outcomes and components of metabolic syndrome. Post-intervention means and standard deviations were pooled using inverse variance methods and random-effects models to calculate mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (CI)., Results: Searching identified 2598 articles, of which 15 articles reporting data from 10 trials, with 1160 participants were included in this review. Compared to usual care, supervised lifestyle intervention demonstrated significant improvements in all but one of the components of metabolic syndrome. Reductions were seen in waist circumference (-4.9 cm, 95%CI -8.0 to -1.7), systolic blood pressure (-6.5 mmHg, 95%CI -10.7 to -2.3), diastolic blood pressure (-1.9 mmHg, 95%CI -3.6 to -0.2), triglycerides (SMD -0.46, 95%CI -0.88 to -0.04) and fasting glucose (SMD -0.68, 95%CI -1.20 to -0.15). Prevalence of metabolic syndrome was reduced by 39% in intervention group participants compared to control group participants (Risk Ratio 0.61, 95%CI 0.38 to 0.96). Improvements in quality of life were not statistically significant., Conclusion: There is low to moderate quality evidence that supervised multifaceted lifestyle intervention improves multiple risk factors of metabolic syndrome, as well as reducing prevalence of the disease. Health services should consider implementing lifestyle intervention programs for people with metabolic syndrome to improve health outcomes and prevent progression to chronic disease., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Background: Grit, resilience and a growth mindset are personal traits conducive to optimal learning and clinical readiness. These are important traits to consider with regards to whether a student thrives or struggles in challenging situations. Research with medical, nursing and pharmacy students demonstrates correlations of these traits with positive well-being and academic success. No research has investigated the traits of resilience, grit and mindset type together in health professional students to explore whether they are related, and none have focused on physiotherapy students., Methods: Cross-sectional study of final-year physiotherapy students (n = 134) aiming to describe the levels of these personal traits and to determine whether they are related to each other or demographic factors., Results: A proportion of physiotherapy students have low levels of resilience (25%), low academic resilience (19%) and low levels of grittiness (13%). Grit and resilience were positively related (p < 0.001). A smaller fraction of students had a fixed mindset in relation to intelligence (7%) and talent (10%). Having a mental health condition or disability and the number of hours spent in paid employment were related to personal traits., Discussion: This is the first study to document empirical evidence of physiotherapy students' levels of grit, resilience and mindset type with a significant proportion of students having low levels of these attributes. Results have implications for clinical educators and universities seeking to improve student well-being in order to facilitate effective learning. Institutions need to consider best-practice approaches to managing and supporting these students to foster well-being for effective learning., (© 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Tea-waste is an abundant feedstock for producing biochar (BC) which is considered to be a cost effective carbonaceous adsorbent useful for water remediation and soil amendment purposes. In the present study, tea-waste BC (TWBC) produced at three different temperatures were subjected to nitric, sulfuric and hydrochloric acid modifications (abbreviated as NM, SM and HM respectively). Characteristics of the raw and modified BC such as ultimate and proximate analyses, surface morphology, surface acidity and functionality, point of zero charge, cation exchange capacity (CEC) and thermal stability were compared to evaluate the influence of pyrolysis temperature and of modifications incorporated. The amount of carboxylic and phenolic surface functionalities on TWBC was seen to decrease by 93.44% and 81.06% respectively when the pyrolysis temperature was increased from 300 to 700 °C. Additionally, the yield of BC was seen to decrease by 46% upon the latter temperature increment. The elemental analysis results provided justification for high-temperature BC being more hydrophobic as was observed by the 61% increase in H/C ratio which is an indication of augmented aromatization. The CEC was the highest for the low-temperature BC and was seen to further increase by NM which is attributed to the 81.89% increase in carboxylic functionalities. The surface area was seen to significantly increase for BC700 upon NM (∼27 times). The SM led to pore wall destruction which was observed in scanning electron microscopy images. Findings would enable the rational use of these particular modifications in relevant remediation and soil amendment applications., Competing Interests: There are no conflicts of interest to declare., (This journal is © The Royal Society of Chemistry.)

Background: This study compared levels of physical activity completed by adults with and without Down syndrome., Method: Fifteen adults with and 15 adults without Down syndrome matched for age and gender, took part. The intensity and duration of physical activity were measured using RT3 accelerometers worn for seven days., Results: Only, 12 participants with Down syndrome had complete physical activity data, and these participants and their matched controls (total: six females, 18 males; aged 25.8 ± 9.7) were included in the analyses. There were significantly lower levels of moderate and vigorous physical activity per day for people with Down syndrome (median = 27 min) compared to those without (median = 101 min) (p < .001). Participants without disability were twice more likely to achieve recommended levels of physical activity than people with Down syndrome., Conclusions: Adults with Down syndrome appear to participate in lower levels of physical activity than adults without Down syndrome. Further research should validate these estimates., (© 2017 John Wiley & Sons Ltd.)

Objective: To determine how much moderate-intensity physical activity, in the form of walking, could be prescribed for people living in the community after hip fracture in terms of safety, tolerability, and feasibility., Design: Phase I dose-response design., Setting: Public community rehabilitation centers., Participants: Community-dwelling adults (N=21; 16 women; mean age, 75±9y) who were cognitively alert, attending community rehabilitation after hip fracture (mean days postfracture, 110±47d), able to walk with or without a gait aid, and for whom it was safe to participate in physical activity., Interventions: Individually supervised doses of moderate-intensity walking completed in 1 week in addition to their usual levels of physical activity. Three participants were required to complete a dose of walking before dose escalation for the next cohort of 3 participants. Dose escalation ceased when >1 participant in a cohort had an adverse event or was unable to tolerate the dose or if the maximum dose of 150min/wk was achieved., Main Outcome Measures: Maximum tolerated dose of walking per week (in minutes), adverse events, mobility, and walking confidence., Results: The maximum tolerated dose of walking for adults after hip fracture before significant discomfort was experienced (eg, breathlessness, pain, and fatigue) by any participant was 100min/wk. No adverse events occurred, but participants began to be unable to tolerate higher doses beyond 100min/wk., Conclusions: This provides preliminary evidence that community-dwelling older adults recovering from hip fracture can complete a sufficient amount of moderate-intensity physical activity to maintain and improve their health., (Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Utilization of biochar (BC) as a low cost adsorbent for water remediation has gained an immense research interest due to their surface functionality and porosity. Although many reports on the BC based sorptive removal of Sulfonamides (SA) and Tetracyclines (TC) are available in literature, a deep insight into sorption mechanisms is yet to be reviewed. Objective of this review is to fill the research gap of a methodological understanding of sorption mechanisms and characteristics which is essential to develop efficient methods for contaminant removal. The most common adsorption mechanism can be considered as electron donor-acceptor interactions of electron withdrawing moieties with surface arene rings. The strongest adsorption of both antibiotics occurs at mildly acidic pH where the dominant species are zwitterionic or cationic. Smaller SAs exhibit micro pore-filling effects while bulky TCs experience size exclusions. Furthermore, the effect of matrix components and modifications are also been taken into account., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Questions: Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay?, Design: This study pooled individual data from two randomised, controlled trials (n=350) using an individual patient data meta-analysis and multivariate regression., Participants: People with stroke admitted to inpatient rehabilitation facilities., Intervention: Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy)., Outcome Measures: Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life., Results: Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge., Discussion: Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay., Clinical Trial Registration: ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.Journal of Physiotherapy62: 124-129]., (Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Background: Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy, and has been related to lumbopelvic instability and pelvic floor weakness. Women with DRAM are commonly referred to physiotherapists for conservative management, but little is known about the effectiveness of such strategies., Objectives: To determine if non-surgical interventions (such as exercise) prevent or reduce DRAM., Data Sources: EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro were searched., Study Selection/eligibility: Studies of all designs that included any non-surgical interventions to manage DRAM during the ante- and postnatal periods were included., Study Appraisal and Synthesis Methods: Methodological quality was assessed using a modified Downs and Black checklist. Meta-analysis was performed using a fixed effects model to calculate risk ratios (RR) and 95% confidence intervals (CI) where appropriate., Results: Eight studies totalling 336 women during the ante- and/or postnatal period were included. The study design ranged from case study to randomised controlled trial. All interventions included some form of exercise, mainly targeted abdominal/core strengthening. The available evidence showed that exercise during the antenatal period reduced the presence of DRAM by 35% (RR 0.65, 95% CI 0.46 to 0.92), and suggested that DRAM width may be reduced by exercising during the ante- and postnatal periods., Limitations: The papers reviewed were of poor quality as there is very little high-quality literature on the subject., Conclusion and Implications: Based on the available evidence and quality of this evidence, non-specific exercise may or may not help to prevent or reduce DRAM during the ante- and postnatal periods., (Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Objectives: To describe the MR imaging findings in adults presenting with anal incontinence following pull-through perineoplasty for anorectal atresia., Methods: 15 adults (12 male, 3 female; age 22-52 years) with anal incontinence following a prior perineal pull-through procedure as an infant for anorectal atresia were identified retrospectively. MR imaging was performed using either an endoanal coil or body coil. MR images were reviewed by three observers who noted whether pelvic floor and sphincter muscles were present and, if so, whether they were thinned or not. Data were tabulated and raw frequencies determined., Results: Images were unavailable for one patient, leaving 14 for analysis. Anal stenosis prevented endoanal coil placement in 5. The pull-through was anatomically correct in 12 (86 %) patients but was misdirected in 2. Thinned muscle was seen in 11 (79 %) patients. External sphincter thinning was commonest (present in 10 patients), with levator plate thinning least common (present in 4 patients). Only one patient had thinning of all muscle groups., Conclusion: MR imaging may be used to determine the extent and quality of residual pelvic floor and anal sphincter muscle in adults who have functional disability following pull-through perineoplasty for anorectal agenesis.

Background: Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service., Methods/design: A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial., Discussion: This paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services., Clinical Trial Registration Number: Australian and New Zealand Clinical Trials Registry ACTRN12609000973213.

This study investigated the variability in baseline computed tomography colonography (CTC) performance using untrained readers by documenting sources of error to guide future training requirements. Twenty CTC endoscopically validated data sets containing 32 polyps were consensus read by three unblinded radiologists experienced in CTC, creating a reference standard. Six readers without prior CTC training [four residents and two board-certified subspecialty gastrointestinal (GI) radiologists] read the 20 cases. Readers drew a region of interest (ROI) around every area they considered a potential colonic lesion, even if subsequently dismissed, before creating a final report. Using this final report, reader ROIs were classified as true positive detections, true negatives correctly dismissed, true detections incorrectly dismissed (i.e., classification error), or perceptual errors. Detection of polyps 1-5 mm, 6-9 mm, and > or =10 mm ranged from 7.1% to 28.6%, 16.7% to 41.7%, and 16.7% to 83.3%, respectively. There was no significant difference between polyp detection or false positives for the GI radiologists compared with residents (p=0.67, p=0.4 respectively). Most missed polyps were due to failure of detection rather than characterization (range 82-95%). Untrained reader performance is variable but generally poor. Most missed polyps are due perceptual error rather than characterization, suggesting basic training should focus heavily on lesion detection.

Objective: The purpose of our study was to compare the effects of automated and manual carbon dioxide insufflation before CT colonography on distention and patient acceptance., Subjects and Methods: One hundred forty-one symptomatic subjects underwent CT colonography using either an automated device (n = 47) or a manual method (n = 94) for carbon dioxide insufflation. CT data sets were assessed retrospectively in consensus by two blinded observers who graded distention for six colonic segments using a 4-point scale. An additional assessment of the overall clinical adequacy of distention (yes/no) was also made, and any learning curve was sought. Each patient completed a validated 24-point patient questionnaire reflecting patient satisfaction and discomfort. Distention scores, clinical adequacy, and questionnaire responses were analyzed using ordered logistic regression, Fisher's exact test, and the Mann-Whitney test statistic, respectively., Results: Automated insufflation significantly improved distention overall (p = 0.001). For individual segments, distention was significantly improved in the sigmoid (p = 0.007) and descending (p < 0.001) colons when the patient was supine; and in the sigmoid (p = 0.02), descending (p = 0.001), and transverse (p = 0.02) colons when supine and prone positions were combined. No significant difference was seen in the clinical adequacy of distention, nor was there evidence of any learning curve for either insufflation method. Subjects were more weary after automated insufflation (p = 0.03), but no significant difference was seen for the remaining 23 questionnaire items or for feelings of bloating or discomfort., Conclusion: Automated carbon dioxide insufflation significantly improves colonic distention compared with manual insufflation. Benefit is greatest in the left colon, particularly when the patient is supine. Patient acceptance is similar to that for manual insufflation.

We report the difficulties experienced in identifying and recruiting 21 patients with ocular hypertension or primary open-angle glaucoma to participate in a clinical trial of two topical beta-blockers. The case-notes of 374 consecutive patients expected to attend routine glaucoma clinics were reviewed to recruit 21 eligible patients who were willing to undergo the drug trial. Recruitment of patients to prospective drug trials may be complicated by a high proportion of exclusions due to ineligibility and also by refusal of otherwise eligible patients.