Social exercise interventions for children who have complex developmental needs: A systematic review.

Exercise interventions are identified as effective treatments for children not meeting developmental milestones. This systematic review synthesizes research regarding exercise interventions that involved social participatory elements, for children with complex developmental needs. Academic Search Complete, CINAHL, Emcare, Proquest Theses and Dissertations, MEDLINE, and Google Scholar were searched systematically for relevant studies. Peer-reviewed studies meeting the review aim and published between 2000 and 2021 in English, were included. Methodological quality of 49 eligible studies (47 controlled trials, two mixed methods, total of 2355 participants) was appraised using the Mixed Methods Appraisal Tool. Narrative synthesis identified two groups of studies: Group 1 incorporated intentional social participatory elements; Group 2 likely involved incidental social participation. Most studies were of moderate to low methodological quality. Few measured impacts of interventions upon total physical activity levels. Short-term improvements in physical outcomes - particularly motor skills - were most frequently reported and were the main benefit of social exercise interventions for children with complex developmental needs, for which evidence exists. Further rigorous, longitudinal research is needed to assess social, psychological, and executive function outcomes of social exercise interventions in this population. Such interventions should incorporate booster sessions to provide children with greater opportunity to meet developmental milestones.

The physiotherapy consultation: A qualitative study of the experience of parents of infants with cystic fibrosis in Australia.

BACKGROUND: Physiotherapy is an essential component in the management of cystic fibrosis (CF). OBJECTIVE: To explore how parents of infants with CF experience physiotherapy clinic consultations. METHODS: A qualitative study, informed by hermeneutic phenomenology, utilizing in-depth semi-structured interviews and daily diaries was conducted with 13 parents of infants (aged 0-2 yrs.) receiving physiotherapy care for CF in Australia. RESULTS: Three themes arose from the text. The first was that parents' physiotherapy clinic experience is influenced by the manner in which health professionals communicate to parents about physiotherapy in CF, as well as their own prior experience and knowledge. Secondly, parents receive conflicting messages from the physiotherapy consultation, but perceive the key message to be to prioritize adherence to physiotherapy. The final theme was that parents' expectations of the physiotherapy interaction were often not met, in particular a lack of practical physiotherapy education and training was reported. CONCLUSION: Parents of infants with CF seek an optimistic, practical and hands on approach during physiotherapy consultations. Exploring options for providing physiotherapy input outside of traditional clinic environments may help accommodate individual needs. Investigation into the manner in which physiotherapy education is communicated to parents is warranted in light of the influence on parents' expectations of physiotherapy.

Physiotherapy: At what cost? Parents experience of performing chest physiotherapy for infants with cystic fibrosis.

Physiotherapy is one of the most burdensome aspects of cystic fibrosis (CF) care. Healthcare requirements for older children with CF are reported to impact parental quality of life and physiotherapy adherence. How parents of infants experience performing chest physiotherapy as a part of CF care is unknown. This study aimed to explore the experience of performing chest physiotherapy for parents of infants with CF. In this study, 13 parents of infants (aged 1-2 years) with CF participated in one in-depth semi-structured interview and completed a daily diary for five days. Principles of hermeneutic phenomenology guided interpretation of interview transcripts, diary entries, and field notes. For these parents, being responsible for performing chest physiotherapy was an ever-present experience of pressure, doubt, and guilt. Managing chest physiotherapy resulted in sacrifices that were perceived by parents as an expected and necessary part of meeting the healthcare needs of their child. Despite perceived sacrifices, performing chest physiotherapy was also experienced by parents as an opportunity to positively impact the health of their child. Awareness of parental perceptions and experiences of chest physiotherapy in CF may enhance the personalization of physiotherapy and minimize burden.

Versican knockdown reduces interzone area during early stages of chick synovial joint development.

Much has been learned regarding factors that specify joint placement, but less is known regarding how these molecular instructions are translated into functional joint tissues. Previous studies have shown that the matrix chondroitin sulfate proteoglycan, versican, exhibits a similar pattern of expression in the embryonic joint rudiment of chick and mouse suggesting conserved function during joint development. In this study, versican's importance in developing joints was investigated by specific inhibition of its expression in the early joint interzone, tissue that gives rise to articular cartilages and joint cavity. In ovo microinjection of adenoviral shRNA constructs into the HH25 chick wing was employed to silence endogenous versican protein in developing appendicular joints. Results showed statistically significant (12-14%) reduction of nonchondrogenic elbow joint interzone area in whole-mount specimens at HH36 in response to versican knockdown. Attenuated expression of key versican-associated molecules including hyaluronan, tenascin, CD44, and link protein was also noted by histochemical and immunohistochemical analysis. Versican knockdown also lowered collagen II expression in presumptive articular chondrocytes indicating possible delay in chondrogenesis. Results suggest that versican functions interactively with other matrix/cell surface molecules to facilitate establishment or maintenance of early joint interzone structure.

Proactive office encounter: a systematic approach to preventive and chronic care at every patient encounter.

In 2007, Kaiser Permanente's (KP) Southern California Region designed and implemented a systematic in-reach program, the Proactive Office Encounter (POE), to address the growing needs of its three million patients for preventive care and management of chronic disease. The program sought staff from both primary and specialty care departments to proactively identify gaps in care and to assist physicians in closing those gaps. The POE engaged the entire health team in a proactive patient-care experience, creating standard work flows and using information technology to identify gaps in patient care. The goals were to improve consistency of preventive care and improve quality of care for chronic conditions and to improve reliability of staff support for physicians. The POE has been implemented in all outpatient settings in KP's Southern California Region's 13 medical centers and 148 medical office buildings. The program has contributed to significant improvements in key clinical quality metrics, including cancer screenings, blood pressure control, and tobacco cessation. It is now being extended into the inpatient setting and is being shared with other KP Regions.

Versican G1 domain and V3 isoform overexpression results in increased chondrogenesis in the developing chick limb in ovo.

Previous work has shown that versican proteoglycan is highly expressed in the extracellular matrix of precartilage limb mesenchyme. Although much of versican's role in chondrogenesis has been attributed to its glycosaminoglycan complement, N- and C-terminal G1 and G3 domains of versican have been shown to possess distinct functions when expressed ectopically. This study was undertaken to test the hypothesis that overexpression of the versican G1 domain and short V3 isoform, comprised of only G1 and G3, in the chick wing in ovo would result in increased chondrogenesis, suggesting function for discrete versican domains in limb skeletal development. Recombinant adenoviruses encoding G1 and V3 proteins were microinjected into proximal HH19-25 chick wing buds which resulted in significant enlargement of humeral primordia at HH35. Enhanced cartilage deposition appeared due to increased chondrogenic aggregation as a result of recombinant G1 or V3 overexpression, further implicating versican in early stages of limb development.

Identification and comparison of electrical tapes using instrumental and statistical techniques: II. Organic composition of the tape backing and adhesive.

The microtexture and elemental composition of the backing of electrical tapes have been shown to be highly discriminating. In this study, the organic composition of electrical tape was evaluated as a complementary means of distinguishing tape brands. The backing and adhesive of 72 rolls of electrical tape were analyzed via Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR FTIR) and discriminant analysis was used to classify all samples by brand. Generally, the accuracy for FTIR data (88-99%) was higher than that for elemental data (86-94%). FTIR spectra from the adhesive layer were the most discriminating. In separate studies, two fragments of blast-damaged tape were correctly assigned to their brand of origin and discriminant analysis was used to quantitatively associate or exclude tape samples from two bombing cases.

Identification and comparison of electrical tapes using instrumental and statistical techniques: I. Microscopic surface texture and elemental composition.

Comparisons of polyvinyl chloride electrical tape typically rely upon evaluating class characteristics such as physical dimensions, surface texture, and chemical composition. Given the various techniques that are available for this purpose, a comprehensive study has been undertaken to establish an optimal analytical scheme for electrical tape comparisons. Of equal importance is the development of a quantitative means for sample discrimination. In this study, 67 rolls of black electrical tape representing 34 different nominal brands were analyzed via scanning electron microscopy and energy dispersive spectroscopy. Differences in surface roughness, calendering marks, and filler particle size were readily apparent, including between some rolls of the same nominal brand. The relative amounts of magnesium, aluminum, silicon, sulfur, lead, chlorine, antimony, calcium, titanium, and zinc varied greatly between brands and, in some cases, could be linked to the year of manufacture. For the first time, quantitative differentiation of electrical tapes was achieved through multivariate statistical techniques, with 36 classes identified within the sample population. A single-blind study was also completed where questioned tape samples were correctly associated with known exemplars. Finally, two case studies are presented where tape recovered from an improvised explosive device is compared with tape recovered from a suspect.