Coupling online control and inhibitory systems in children with developmental coordination disorder: goal-directed reaching

For children with Developmental Coordination Disorder (DCD), the real-time coupling between frontal executive function and online motor control has not been explored despite reported deficits in each domain. The aim of the present study was to investigate how children with DCD enlist online control under task constraints that compel the need for inhibitory control. A total of 129 school children were sampled from mainstream primary schools. Forty-two children who met research criteria for DCD were compared with 87 typically developing controls on a modified double-jump reaching task. Children within each skill group were divided into three age bands: younger (6-7 years), mid-aged (8-9), and older (10-12). Online control was compared between groups as a function of trial type (non-jump, jump, anti-jump). Overall, results showed that while movement times were similar between skill groups under simple task constraints (non-jump), on perturbation (or jump) trials the DCD group were significantly slower than controls and corrected trajectories later. Critically, the DCD group was further disadvantaged by anti-jump trials where inhibitory control was required; however, this effect reduced with age. While coupling online control and executive systems is not well developed in younger and mid-aged children, there is evidence of age-appropriate coupling in older children. Longitudinal data are needed to clarify this intriguing finding. The theoretical and applied implications of these results are discussed.

Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis.

To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions.

Validation of a trunk-mounted accelerometer to measure peak impacts during team sport movements

This study assessed the validity of an accelerometer to measure impacts in team sports. 76 participants completed a team sport circuit. Accelerations were collected concurrently at 100 Hz using an accelerometer and a 36-camera motion analysis system. The largest peak accelerations per movement were compared in 2 ways: i) pooled together and filtered at 13 different cut-off frequencies (range 6-25 Hz) to identify the optimal filtering frequency, and ii) the optimal cut-off frequency split into the 7 movements performed (n=532). Raw and 25-16 Hz filtering frequencies significantly overestimated and 6 Hz underestimated motion analysis peak accelerations (P <0.007). The 12 Hz filtered accelerometer data revealed the strongest relationship with motion analysis data (accuracy - 0.01±0.27 g, effect size - 0.01, agreement - 0.55 to 0.53 g, precision 0.27 g, and relative error 5.5%; P=1.00). The accelerometer underestimated peak accelerations during tackling and jumping, and overestimated during walking, jogging, sprinting and change of direction. Lower agreement and reduced precision were associated with sprinting, jumping and tackling. The accelerometer demonstrated an acceptable level of concurrent validity compared to a motion analysis system when filtered at a cut-off frequency of 12 Hz. The results advocate the use of accelerometers to measure movements in team sport.

Community aged care case managers transitioning to consumer directed care: more than procedural change required

Consumer directed care (CDC) is increasing in community aged care. However, limited information is available to successfully transition social workers and other case managers to their new role. This paper reports on a case study of six senior case managers who supervised staff in three Australian community-aged care agencies as they transitioned from agency directed care to consumer directed care. A change management framework was used to analyse the qualitative data collected in 12 semistructured interviews. A key finding is that changes in values, attitudes, and organisational culture are needed before staff can fully implement CDC principles of service user self-determination, empowerment, and choice. Process changes needed to assist staff transition to CDC are: using a change management strategy that maximises certainty; monitoring and responding to feelings of anxiety through ongoing consultations; and providing ongoing education and support in group sessions.

Reduced graphene oxide directed self-assembly of phospholipid monolayers in liquid and gel phases

The response of cell membranes to the local physical environment significantly determines many biological processes and the practical applications of biomaterials. A better understanding of the dynamic assembly and environmental response of lipid membranes can help understand these processes and design novel nanomaterials for biomedical applications. The present work demonstrates the directed assembly of lipid monolayers, in both liquid and gel phases, on the surface of a monolayered reduced graphene oxide (rGO). The results from atomic force microscopy indicate that the hydrophobic aromatic plane and the defect holes due to reduction of GO sheets, along with the phase state and planar surface pressure of lipids, corporately determine the morphology and lateral structure of the assembled lipid monolayers. The DOPC molecules, in liquid phase, probably spread over the rGO surface with their tails associating closely with the hydrophobic aromatic plane, and accumulate to form circles of high area surrounding the defect holes on rGO sheets. However, the DPPC molecules, in gel phase, prefer to form a layer of continuous membrane covering the whole rGO sheet including defect holes. The strong association between rGO sheets and lipid tails further influences the melting behavior of lipids. This work reveals a dramatic effect of the local structure and surface property of rGO sheets on the substrate-directed assembly and subsequent phase behavior of the supported lipid membranes.

Protocol-directed sedation versus non-protocol-directed sedation to reduce duration of mechanical ventilation in mechanically ventilated intensive care patients (review)

Background : The sedation needs of critically ill patients have been recognized as a core component of critical care and meeting these is vital to assist recovery and ensure humane treatment. There is growing evidence to suggest that sedation requirements are not always optimally managed. Sub-optimal sedation incorporates both under- and over-sedation and has been linked to both short-term (e.g. length of stay) and long-term (e.g. psychological recovery) outcomes. Various strategies have been proposed to improve sedation management and address aspects of assessment as well as delivery of sedation.

Objectives : To assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit (ICU) patients. We looked at various outcomes and examined the role of bias in order to examine the level of evidence for this intervention.

Search methods : We searched the Cochrane Central Register of Controlled trials (CENTRAL) (2013; Issue 11), MEDLINE (OvidSP) (1990 to November 2013), EMBASE (OvidSP) (1990 to November 2013), CINAHL (BIREME host) (1990 to November 2013), Database of Abstracts of Reviews of Effects (DARE) (1990 to November 2013), LILACS (1990 to November 2013), Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990 to November 2013), and reference lists of articles. We re-ran the search in October 2014. We will deal with any studies of interest when we update the review.

Selection criteria : We included randomized controlled trials (RCTs) conducted in adult ICUs comparing management with and without protocol-directed sedation.

Data collection and analysis : Two authors screened the titles and abstracts and then the full-text reports identified from our electronic search. We assessed seven domains of potential risk of bias for the included studies. We examined the clinical, methodological and statistical heterogeneity and used the random-effects model for meta-analysis where we considered it appropriate. We calculated the mean difference (MD) for duration of mechanical ventilation and risk ratio (RR) for mortality across studies, with 95% confidence intervals (CI).

Main results : We identified two eligible studies with 633 participants. Both included studies compared the use of protocol-directed sedation, specifically protocols delivered by nurses, with usual care. We rated the risk of selection bias due to random sequence generation low for one study and unclear for one study. The risk of selection bias related to allocation concealment was low for both studies. We also assessed detection and attrition bias as low for both studies while we considered performance bias high due to the inability to blind participants and clinicians in both studies. Risk due to other sources of bias, such as potential for contamination between groups and reporting bias, was considered unclear. There was no clear evidence of differences in duration of mechanical ventilation (MD -5.74 hours, 95% CI -62.01 to 50.53, low quality evidence), ICU length of stay (MD -0.62 days, 95% CI -2.97 to 1.73) and hospital length of stay (MD -3.78 days, 95% CI -8.54 to 0.97) between people being managed with protocol-directed sedation versus usual care. Similarly, there was no clear evidence of difference in hospital mortality between the two groups (RR 0.96, 95% CI 0.71 to 1.31, low quality evidence). ICU mortality was only reported in one study preventing pooling of data. There was no clear evidence of difference in the incidence of tracheostomy (RR 0.77, 95% CI 0.31 to 1.89). The studies reported few adverse event outcomes; one study reported self extubation while the other study reported re-intubation; given this difference in outcomes, pooling of data was not possible. There was significant heterogeneity between studies for duration of mechanical ventilation (I2 = 86%, P value = 0.008), ICU length of stay (I2 = 82%, P value = 0.02) and incidence of tracheostomy (I2 = 76%, P value = 0.04), with one study finding a reduction in duration of mechanical ventilation and incidence of tracheostomy and the other study finding no difference.

Authors' conclusions : There is currently insufficient evidence to evaluate the effectiveness of protocol-directed sedation. Results from the two RCTs were conflicting, resulting in the quality of the body of evidence as a whole being assessed as low. Further studies, taking into account contextual and clinician characteristics in different ICU environments, are necessary to inform future practice. Methodological strategies to reduce the risk of bias need to be considered in future studies.

A pilot, multisite, randomized controlled trial of a self-directed coping skills training intervention for couples facing prostate cancer : accrual, retention, and data collection issues

PURPOSE: To examine the acceptability of the methods used to evaluate Coping-Together, one of the first self-directed coping skill intervention for couples facing cancer, and to collect preliminary efficacy data. METHODS: Forty-two couples, randomized to a minimal ethical care (MEC) condition or to Coping-Together, completed a survey at baseline and 2 months after, a cost diary, and a process evaluation phone interview. RESULTS: One hundred seventy patients were referred to the study. However, 57 couples did not meet all eligibility criteria, and 51 refused study participation. On average, two to three couples were randomized per month, and on average it took 26 days to enrol a couple in the study. Two couples withdrew from MEC, none from Coping-Together. Only 44 % of the cost diaries were completed, and 55 % of patients and 60 % of partners found the surveys too long, and this despite the follow-up survey being five pages shorter than the baseline one. Trends in favor of Coping-Together were noted for both patients and their partners. CONCLUSIONS: This study identified the challenges of conducting dyadic research, and a number of suggestions were put forward for future studies, including to question whether distress screening was necessary and what kind of control group might be more appropriate in future studies.

Reduced mu suppression and altered motor resonance in euthymic bipolar disorder: evidence for a dysfunctional mirror system?

Social cognitive difficulties are common in the acute phase of bipolar disorder and, to a lesser extent, during the euthymic stage, and imaging studies of social cognition in euthymic bipolar disorder have implicated mirror system brain regions. This study aimed to use a novel multimodal approach (i.e., including both transcranial magnetic stimulation (TMS) and electroencephalogram (EEG)) to investigate mirror systems in bipolar disorder. Fifteen individuals with euthymic bipolar disorder and 16 healthy controls participated in this study. Single-pulse TMS was applied to the optimal site in the primary motor cortex (M1), which stimulates the muscle of interest during the observation of hand movements (goal-directed or interacting) designed to elicit mirror system activity. Single EEG electrodes (C3, CZ, C4) recorded mu rhythm modulation concurrently. Results revealed that the patient group showed significantly less mu suppression compared to healthy controls. Surprisingly, motor resonance was not significantly different overall between groups; however, bipolar disorder participants showed a pattern of reduced reactivity on some conditions. Although preliminary, this study indicates a potential mirror system deficit in euthymic bipolar disorder, which may contribute to the pathophysiology of the disorder.

Home range, habitat use and movements by the little raven (Corvus mellori) in a coastal peri-urban landscape

Context In peri-urban environments, high availability of anthropogenic resources may result in relatively high abundances of some species, with potentially negative implications for other native biota. Effective management of such impacts requires understanding of the spatial ecology of problem species. However, home range and habitat use have not been described for the little raven (Corvus mellori), a superabundant native predator that occurs in urban and natural habitats, including those where threatened shorebirds breed. Aims The aim of this study was to provide basic information on little raven home range, habitat use and movements in a coastal peri-urban landscape. Methods Between October 2011 and January 2012 we radio-tracked 20 little ravens captured in a coastal wetland (near Melbourne, Australia). Key results Little ravens were highly mobile, moving up to 9.9km in an hour (median≤2km), and had large ranges: Minimum Convex Polygons were 1664-9989ha (median≤3362ha). Although most birds used both anthropogenic and natural habitats, some birds strongly selected for coastal wetland habitat. Birds used multiple roosts during the study period, most of which occurred in grassland (58.7%) or urban (22.3%) areas. Movement of up to 8.3km (median≤2.2km) between roosts during the night was also detected. Conclusions Ravens were highly mobile and used large home ranges and a variety of habitats, with habitat preferences varying between birds. Implications Considering the large home ranges and inter-individual variation in habitat preferences of little raven populations, localised management to reduce their impacts on breeding shorebirds is unlikely to be successful. Journal compilation

Detection of dynamic background due to swaying movements from motion features

Dynamically changing background (dynamic background) still presents a great challenge to many motion-based video surveillance systems. In the context of event detection, it is a major source of false alarms. There is a strong need from the security industry either to detect and suppress these false alarms, or dampen the effects of background changes, so as to increase the sensitivity to meaningful events of interest. In this paper, we restrict our focus to one of the most common causes of dynamic background changes: 1) that of swaying tree branches and 2) their shadows under windy conditions. Considering the ultimate goal in a video analytics pipeline, we formulate a new dynamic background detection problem as a signal processing alternative to the previously described but unreliable computer vision-based approaches. Within this new framework, we directly reduce the number of false alarms by testing if the detected events are due to characteristic background motions. In addition, we introduce a new data set suitable for the evaluation of dynamic background detection. It consists of real-world events detected by a commercial surveillance system from two static surveillance cameras. The research question we address is whether dynamic background can be detected reliably and efficiently using simple motion features and in the presence of similar but meaningful events, such as loitering. Inspired by the tree aerodynamics theory, we propose a novel method named local variation persistence (LVP), that captures the key characteristics of swaying motions. The method is posed as a convex optimization problem, whose variable is the local variation. We derive a computationally efficient algorithm for solving the optimization problem, the solution of which is then used to form a powerful detection statistic. On our newly collected data set, we demonstrate that the proposed LVP achieves excellent detection results and outperforms the best alternative adapted from existing art in the dynamic background literature.

Metabolic power method underestimates energy expenditure in field sport movements using a GPS tracking system

The purpose of this study was to assess the validity of a GPS tracking system to estimate energy expenditure (EE) during exercise and field sport locomotor movements. Twenty-seven participants each completed one 90 minute exercise session on an outdoor synthetic futsal pitch. During the exercise session participants wore a 5 Hz GPS unit interpolated to 15 Hz (SPI HPU, GPSports Pty Ltd, Australia) and a portable gas analyser (Metamax® 3B, Cortex Pty Ltd, Germany) which acted as the criterion measure of EE. The exercise session was comprised of alternating five minute exercise bouts of randomised walking, jogging, running or a field sport circuit (x3) followed by 10 minutes of recovery. One-way ANOVA showed significant (p<0.01) and very large underestimations between GPS metabolic power derived EE and VO2 derived EE for all field sport circuits (% difference ≈ -44%). No differences in EE were observed for the jog (7.8%) and run (4.8%) while very large overestimations were found for the walk (43.0%). The GPS metabolic power EE over the entire 90 minute session was significantly lower (p<0.01) than the VO2 EE, resulting in a moderate underestimation overall (-19%). The results of this study suggest that a GPS tracking system using the metabolic power model of EE does not accurately estimate EE in field sport movements or over an exercise session consisting of mixed locomotor activities interspersed with recovery periods; however is able to provide a reasonably accurate estimation of EE during continuous jogging and running.