The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his ...clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
Inclusive education for children with attention deficit hyperactivity disorder (ADHD) presents challenges for school staff and professional development is lacking. Training is not always available ...when needed, strategies suggested by external experts can be impractical and staff lack autonomy in choosing the best way of being resourced. Additionally, the experience and knowledge of the range of school staff is not utilised. A collaborative working group of school staff and a researcher explored an alternative method of ADHD resourcing. Co-construction of knowledge defines how the group discursively identified actionable knowledge from the different perspectives and knowledge brought by individual group members. A systemic framework was used to critically reflect on the collaboration. The framework enabled reflection on four areas to understand how and why the collaboration led to a published web-based school staff ADHD resource. Firstly, starting conditions and assumptions were considered to identify and articulate the rationale for the resource. Secondly, the context and system dynamics enabled consideration of the socio-cultural and political landscape of the project and the impact of COVID-19. Thirdly, the different voices of participants and power dynamics were reflected on. Finally, emergence was a frame in which to elucidate knowledge production and changes in practice. The collaborative working group addressed the research--practice gap and the need for diversity of voices to be heard across the school. Knowledge co-construction positions staff as knowledge bearers and, together with different forms of knowledge, they can be empowered to create new, contextualised evidence-based knowledge.
•A third of women were diagnosed with type 2 diabetes within 15 years after gestational diabetes.•Risk of type 2 diabetes was 8-times higher among women with gestational diabetes.•Risk of diabetes ...was higher in non-White European and overweight populations.•Women with gestational diabetes represent an easily-identifiable high risk group.
To estimate development of type 2 diabetes (T2DM) in women with previous gestational diabetes (GDM) and investigate characteristics associated with higher diagnoses, building on previous meta-analyses and exploring heterogeneity.
Systematic literature review of studies published up to October 2019. We included studies reporting progression to T2DM ≥6 months after pregnancy, if diagnostic methods were reported and ≥50 women with GDM participated. We conducted random-effects meta-analyses and meta-regression of absolute and relative T2DM risk. PROSPERO ID: CRD42017080299.
In 129 included studies, the percentage diagnosed with T2DM was 12% (95% confidence interval 8–16%) higher for each additional year after pregnancy, with a third developing diabetes within 15 years. Development was 18% (5–34%) higher per unit BMI at follow-up, and 57% (39–70%) lower in White European populations compared to others (adjusted for ethnicity and follow-up). Women with GDM had a relative risk of T2DM of 8.3 (6.5–10.6). 17.0% (15.1–19.0%) developed T2DM overall, although heterogeneity between studies was substantial (I2 99.3%), and remained high after accounting for various study-level characteristics.
Percentage developing T2DM after GDM is highly variable. These findings highlight the need for sustained follow-up after GDM through screening, and interventions to reduce modifiable risk factors.
Although the number of resource provision (RP) classrooms for the education of students with special educational needs and/or disabilities (SEND) in English mainstream schools has increased, very ...little is known about their functioning and impact. Through collaborative research, based on critical communicative methodology, this study aims to (i) evaluate with the participants the effective practices and challenges in educating students with SEND in RP and mainstream classrooms, and (ii) discuss the position of RP within the inclusion and exclusion debate. Reflective conversations, communicative focus groups and communicative observations were conducted with teachers, teaching assistants, mothers and students in three schools. Two different models were identified in the conceptualisation and practice of RP; either as a service to promote the education and inclusion of students with SEND in mainstream classroom/school, or as a space for specialised provision with opportunities for inclusion. These models reflect two different approaches in the education of these students, the rights‐ and the needs‐based approach respectively. We argue that RP as inclusive service should be prioritised. However, flexibility in its conceptualisation and functioning, either as inclusive service or safe space, can positively contribute towards a realistic approach to inclusion combining human rights and individual diversity perspectives.
Objective:
To synthesize the evidence on the efficacy of ADHD teacher training interventions for teachers’ ADHD knowledge and reducing pupils’ ADHD-type behaviors.
Method:
Six electronic databases ...were systematically searched up to 14/04/20. Meta-analyses were performed to pool standardized mean differences (SMD).
Results:
29 studies were included in the systematic review, and 22 meta-analyzed. SMD for teacher knowledge within subjects at post-test and follow-up was 1.96 (95% confidence interval = 1.48, 2.43) and ‒1.21 (–2.02, –0.41) respectively. Between subjects analyses at post-test showed SMD = 1.56 (0.52, 2.59), with insufficient data at follow-up. At post-test, SMD for pupils’ behavior within and between subjects was 0.78 (0.37, 1.18), and 0.71 (–0.11, 1.52), respectively. Medium-to-high risk of bias was found in all but one study.
Conclusion:
ADHD teacher training programs may be effective in initially improving ADHD teachers’ knowledge. There is inconsistent evidence for their efficacy to reduce students’ ADHD-type behaviors.
Global sea surface temperatures (SSTs) are increasing, and in Hawai'i, rates of ocean warming are projected to double by the end of the 21st century. However, current nearshore warming trends and ...their possible impacts on intertidal communities are not well understood. This study represents the first investigation into the possible effects of rising SST on intertidal algal and invertebrate communities across the Main Hawaiian Islands (MHI). By utilizing citizen-science data coupled with high-resolution, daily SST satellite measurements from 12 intertidal sites across the MHI from 2004-2019, the response of intertidal algal and invertebrate abundance and community diversity to changes in SST was investigated across multiple spatial scales. Results show high rates of SST warming (0.40°C Decade-1) over this study's timeframe, similar to predicted rates of warming for Hawai'i by the end of the 21st century. Changes in abundance and diversity in response to SST were variable among intertidal sites, but differences in antecedent SST among intertidal sites were significantly associated with community dissimilarity. In addition, a statistically significant positive relationship was found between SST and Simpson's diversity index, and a significant relationship was also found between SST and the abundance of six dominant taxa. For five of these six dominant taxa, antecedent SSTs over the 6-12 months preceding sampling were the most influential for describing changes to abundance. The increase in community diversity in response to higher SSTs was best explained by temperatures in the 10 months preceding sampling, and the resultant decreased abundance of dominant turf algae. These results highlight rapidly warming nearshore SSTs in Hawai'i and the longer-term effects of antecedent SSTs as significant drivers of change within Hawaiian intertidal communities. Therefore, we suggest that future research and management should consider the possibility of lagging effects of antecedent SST on intertidal communities in Hawai'i and elsewhere.
Aims
To synthesize the available evidence to better understand the effectiveness of interventions to prevent or delay hyperglycaemia and Type 2 diabetes mellitus (T2DM) postnatally in women with ...current or previous gestational diabetes mellitus (GDM).
Methods
We searched five databases up to December 2020 for primary peer‐reviewed articles reporting postpartum glycaemic outcomes in women with (previous) GDM following pharmacological or lifestyle intervention. Outcomes were relative risk of T2DM or continuous measures of glycaemia, change or at follow‐up. A minimum of two studies evaluating the same intervention‐outcome combination were needed to conduct meta‐analyses, otherwise studies were described narratively. Meta‐regression was used to evaluate whether associations varied by additional variables. We assessed risk of bias using the Critical Appraisal Skills Programme checklist. PROSPERO record CRD42018102380.
Results
We included 31 studies in the review with a total sample size of 8624 participants, and 26 studies in meta‐analyses. Two‐thirds of studies followed up participants at 1 year or less. Pharmacological interventions were associated with reduced risk of T2DM (0.80 95% CI 0.64–1.00, n = 6 studies), as were lifestyle interventions albeit with a smaller effect size (0.88 95% CI 0.76–1.01, n = 12 studies). Dietary and physical activity interventions were associated with a small reduction in fasting plasma glucose, particularly in longer interventions, but inconsistent effects were seen for other continuous outcomes.
Conclusions
Although possibly due to chance, interventions to reduce hyperglycaemia after GDM may be effective. Future research should improve understanding of how interventions affect glucose control and how to optimise interventions for this population.
ABSTRACT
Objectives
The National Framework for Inclusion Health identified the need for collaborative action between the NHS and third sector health to improve access and outcomes for Inclusion ...Health groups. Clinical psychology trainee placements in homelessness settings could be a valuable pathway to improving access to psychological support for people experiencing homelessness and the provision of clinical services, which is key to developing the workforce and a catalyst for the future recruitment of clinical psychologists in the third sector.
Methods
A qualitative evaluation was conducted using semistructured interviews to explore the perspectives of clinical psychology trainees, supervisors, staff in homelessness settings and a peer mentor. Twenty‐two participants were recruited from two universities and six services across the South East, including 11 clinical psychology trainees, six supervisors, four placement staff and one peer mentor.
Results
Placement staff described the value of a psychological approach but identified some challenges to be overcome. Induction was identified as the key to success. Supervisors recognised the breadth and depth added to trainees' knowledge and skills alongside significant challenges. Trainees valued the opportunities to work in homelessness settings and develop their understanding of the role. The peer mentor identified collaborative working as especially important.
Conclusions
Clinical psychology trainee placements are a necessary programme to fulfil the NHS vision for Inclusion Health. These placements equip the health and social care workforce to create excellent and sustainable provisions to improve the physical and mental health of people experiencing homelessness whilst also providing much‐needed psychological support for staff.
Patient and Public Contribution
Psychologically Informed Environments Through Staff Training: Staff training and support within these placements contribute to the development of psychologically informed environments. This not only leads to better outcomes for both staff and clients but also aligns with the objectives of the National Framework for Inclusion Health, fostering sustainable provision for the health needs of people experiencing homelessness (PEH).
Enhanced Therapeutic Adaptability: Trainees gain invaluable experience in adapting therapy to meet the diverse needs of clients, benefiting both trainees and clients alike. This adaptability fosters more effective therapeutic relationships and contributes to the improvement of inclusion health provision in the long term.
Tailored Therapy for Timely Intervention: Clinical psychology trainee placements in homelessness settings offer therapy that bypasses long waiting times for interventions, crucial for individuals experiencing homelessness. This flexible approach caters to the unpredictable engagement levels of PEH, ensuring timely support aligning with the Health and Care Act 2022 to improve overall health and address health disparities through primary care networks.
The most difficult clinical questions in stroke rehabilitation are “What is this patient’s potential for recovery?” and “What is the best rehabilitation strategy for this person, given her/his ...clinical profile?” Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
To explore the potential modes of Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) transmission, we collected 535 diverse clinical and environmental samples from 75 infected hospitalized and ...community patients. Infectious SARS-CoV-2 with quantitative burdens varying from 5 plaque-forming units/mL (PFU/mL) up to 1.0 × 10
PFU/mL was detected in 151/459 (33%) of the specimens assayed and up to 1.3 × 10
PFU/mL on fomites with confirmation by plaque morphology, PCR, immunohistochemistry, and/or sequencing. Infectious virus in clinical and associated environmental samples correlated with time since symptom onset with no detection after 7-8 days in immunocompetent hosts and with N-gene based C
values ≤ 25 significantly predictive of yielding plaques in culture. SARS-CoV-2 isolated from patient respiratory tract samples caused illness in a hamster model with a minimum infectious dose of ≤ 14 PFU. Together, our findings offer compelling evidence that large respiratory droplet and contact (direct and indirect i.e., fomites) are important modes of SARS-CoV-2 transmission.
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