Effectiveness of wheelchair skills training for improving manual wheelchair mobility in children and adolescents: protocol for a multicenter randomized waitlist-controlled trial.

BACKGROUND: Self-directed mobility during childhood can influence development, social participation, and independent living later in life. For children who experience challenges with walking, manual wheelchairs (MWCs) provide a means for self-directed mobility. An effective MWC skills training program exists for adults, but controlled trials have not yet been documented in children and adolescents. This paper outlines the protocol for a multi-centre randomized wait-list controlled trial. The primary objective is to test the hypothesis that children and adolescents who receive MWC skills training will have higher MWC skills capacity compared to children and adolescents in the control group who receive usual care. The secondary objectives are to explore the influence of MWC skills training in children and adolescents (MWC use self-efficacy and satisfaction with participation in meaningful activities), and parents (perceived MWC skills); and to measure retention three months later. METHODS: A multi-centre, parallel-group, single-blind randomized wait-list controlled trial will be conducted. A sample of 60 children and adolescents who use MWCs will be recruited in rehabilitation centres, specialized schools, and the communities of three Canadian cities. Participants will be randomized (1:1) to the experimental (Wheelchair Skills Training Program [WSTP]) or wait-list control group (usual care). Performance-based and self-report measures will be completed at baseline (T1), three months (post-intervention, T2), and three months post-intervention (T3). The primary outcome will be MWC skills capacity post-intervention. Secondary outcomes will be MWC use self-efficacy and satisfaction with participation of the child/adolescent, and parent-perceived MWC skills. The WSTP will consist of 12 sessions, 45-60 min each, delivered 1-2 times per week by trained personnel with health professions education. Training will be customized according to the child's baseline skills and participation goals that require the use of the MWC. The wait-list control group will receive usual care for 3 months and then receive the WSTP after completing T2 evaluations. Data will be analysed using ANCOVA (controlling for baseline scores). DISCUSSION: MWC skills training may be one way to improve self-directed mobility and related outcomes for children and adolescents. The results of this multi-centre randomized wait-list controlled trial will allow for the effectiveness of the intervention to be evaluated in a variety of clinical contexts and geographical regions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05564247, Version October 3, 2022.

Wheelchair Mobility Confidence Scale for Dutch youth using a manual wheelchair.

Purpose: The objective of this study was to develop a questionnaire to assess confidence in wheelchair mobility in Dutch youth (WheelCon-Mobility Dutch Youth).Methods: (1) A forward-backward translation process was used to translate the original WheelCon-M from English to Dutch. (2) Items related to wheelchair mobility in Dutch youth were selected and adapted based on focus groups with youth, parents and health care professionals to create the WheelCon-Mobility Dutch Youth. (3) The WheelCon-Mobility Dutch Youth and the Utrecht Pediatric Wheelchair Mobility Skills Test 2.0 (UP-WMST 2.0) were administered to 62 participants to evaluate internal consistency and construct validity.Results: Translation and cultural adaptation led to general adaptations in instructions, sentence structure and response scale. At the item level, 24 items were included with (n = 17) and without (n = 7) adaptation, 10 items were deleted and 7 new items were included. The WheelCon-Mobility Dutch Youth had an excellent Cronbach's alpha of 0.924 and a significant correlation (r = 0.44, p < .001) with the UP-WMST 2.0.Conclusions: This study resulted in the adaptation of the WheelCon-M into the WheelCon-Mobility for Dutch youth using a manual wheelchair. Our study suggests there is evidence supporting the internal consistency and construct validity of the WheelCon-Mobility Dutch Youth.Implications for RehabilitationThe WheelCon-Mobility Dutch Youth is a newly developed tool for assessing confidence in wheelchair mobility in Dutch youth using a manual wheelchair.It is important to assess performance and confidence in wheelchair mobility in paediatric rehabilitation.

The effect of operating lights on laminar flow: an experimental study using neutrally buoyant helium bubbles.

AIMS: The interaction between surgical lighting and laminar airflow is poorly understood. We undertook an experiment to identify any effect contemporary surgical lights have on laminar flow and recommend practical strategies to limit any negative effects. MATERIALS AND METHODS: Neutrally buoyant bubbles were introduced into the surgical field of a simulated setup for a routine total knee arthroplasty in a laminar flow theatre. Patterns of airflow were observed and the number of bubbles remaining above the surgical field over time identified. Five different lighting configurations were assessed. Data were analysed using simple linear regression after logarithmic transformation. RESULTS: In the absence of surgical lights, laminar airflow was observed, bubbles were cleared rapidly and did not accumulate. If lights were placed above the surgical field laminar airflow was abolished and bubbles rose from the surgical field to the lights then circulated back to the surgical field. The value of the decay parameter (slope) of the two setups differed significantly; no light (b = -1.589) versus one light (b = -0.1273, p < 0.001). Two lights touching (b = -0.1191) above the surgical field had a similar effect to that of a single light (p = 0. 2719). Two lights positioned by arms outstretched had a similar effect (b = -0.1204) to two lights touching (p = 0.998) and one light (p = 0.444). When lights were separated widely (160 cm), laminar airflow was observed but the rate of clearance of the bubbles remained slower (b = -1.1165) than with no lights present (p = 0.004). CONCLUSION: Surgical lights have a significantly negative effect on laminar airflow. Lights should be positioned as far away as practicable from the surgical field to limit this effect. Cite this article: Bone Joint J 2017;99-B:1061-6.

Magnetically controlled growing rods in the treatment of early-onset scoliosis: a note of caution.

The MAGnetic Expansion Control (MAGEC) system is used increasingly in the management of early-onset scoliosis. Good results have been published, but there have been recent reports identifying implant failures that may be associated with significant metallosis surrounding the implants. This article aims to present the current knowledge regarding the performance of this implant, and the potential implications and strategies that may be employed to identify and limit any problems. We urge surgeons to apply caution to patient and construct selection; engage in prospective patient registration using a spine registry; ensure close clinical monitoring until growth has ceased; and send all explanted MAGEC rods for independent analysis. The MAGEC system may be a good instrumentation system for the treatment of early-onset scoliosis. However, it is innovative and like all new technology, especially when deployed in a paediatric population, robust systems to assess long-term outcome are required to ensure that patient safety is maintained. Cite this article: Bone Joint J 2017;99-B:708-13.

Acromioclavicular joint reconstruction using the LockDown synthetic implant: a study with cadavers.

Dislocation of the acromioclavicular joint is a relatively common injury and a number of surgical interventions have been described for its treatment. Recently, a synthetic ligament device has become available and been successfully used, however, like other non-native solutions, a compromise must be reached when choosing non-anatomical locations for their placement. This cadaveric study aimed to assess the effect of different clavicular anchorage points for the Lockdown device on the reduction of acromioclavicular joint dislocations, and suggest an optimal location. We also assessed whether further stability is provided using a coracoacromial ligament transfer (a modified Neviaser technique). The acromioclavicular joint was exposed on seven fresh-frozen cadaveric shoulders. The joint was reconstructed using the Lockdown implant using four different clavicular anchorage points and reduction was measured. The coracoacromial ligament was then transferred to the lateral end of the clavicle, and the joint re-assessed. If the Lockdown ligament was secured at the level of the conoid tubercle, the acromioclavicular joint could be reduced anatomically in all cases. If placed medial or 2 cm lateral, the joint was irreducible. If the Lockdown was placed 1 cm lateral to the conoid tubercle, the joint could be reduced with difficulty in four cases. Correct placement of the Lockdown device is crucial to allow anatomical joint reduction. Even when the Lockdown was placed over the conoid tubercle, anterior clavicle displacement remained but this could be controlled using a coracoacromial ligament transfer.

Independent validation of the Nottingham Hip Fracture Score and identification of regional variation in patient risk within England.

The Nottingham Hip Fracture Score (NHFS) was developed to assess the risk of death following a fracture of the hip, based on pre-operative patient characteristics. We performed an independent validation of the NHFS, assessed the degree of geographical variation that exists between different units within the United Kingdom and attempted to define a NHFS level that is associated with high risk of mortality. The NHFS was calculated retrospectively for consecutive patients presenting with a fracture of the hip to two hospitals in England. The observed 30-day mortality for each NHFS cohort was compared with that predicted by the NHFS using the Hosmer-Lemeshow test. The distribution of NHFS in the observed group was compared with data from other hospitals in the United Kingdom. The proportion of patients identified as high risk and the mortality within the high risk group were assessed for groups defined using different thresholds for the NHFS. In all 1079 hip fractures were included in the analysis, with a mean age of 83 years (60 to 105), 284 (26%) male. Overall 30-day mortality was 7.3%. The NHFS was a significant predictor of 30-day mortality. Statistically significant differences in the distribution of the NHFS were present between different units in England (p < 0.001). A NHFS ≥ 6 appears to be an appropriate cut-point to identify patients at high risk of mortality following a fracture of the hip.

A case of 'second rupture' following open repair of a ruptured Achilles tendon.

We present a case of Achilles tendon rupture in a 54-year-old man whilst rehabilitating following end-to-end open repair of an acute Achilles tendon rupture. Re-rupture following surgical repair of Achilles tendon is well known. This case however, is atypical as the second rupture occurred significantly proximal to the first rupture. To our knowledge this is the first time this has been described in the English literature. We have termed this incident a 'second rupture'. We describe the surgical technique used by the operating surgeon during open repair of this 'second rupture', involving a gastrocnemius flap turndown. This has lead to the patient making a good recovery, despite complications. This case report serves to inform surgeons of the existence of this type of Achilles tendon rupture, whilst considering possible aetiologies and suggesting a technique for repair of the injury.

Satisfaction with participation using a manual wheelchair among individuals with spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To describe self-identified indoor and outdoor wheelchair-oriented participation outcomes and to report satisfaction with the identified outcomes by people with spinal cord injury (SCI). SETTING: Vancouver, British Columbia. METHODS: Participation outcomes were identified using the Wheelchair Outcome Measure and classified using the International Classification of Functioning, Disability, and Health (ICF). RESULTS: The average age of the 51 community-dwelling subjects with SCI was 43.7(+/-10.7) years. Of them, 84% were men, 64% had tetraplegia and 66% used a manual wheelchair. There were 258 indoor and 257 outdoor participation outcomes identified by this sample with most outcomes falling into the 'community, social, and civil life' (36.5%), 'domestic life' (23.7%) and 'mobility' (18%) domains of the ICF. All domains had a mean satisfaction score of 7.1/10 or greater except for the indoor 'mobility' domain that had a mean satisfaction score of 6.1/10. Satisfaction scores with performance of the specific participation outcomes ranged from high (10/10) to low (2/10) with most scores falling above 7/10. CONCLUSION: Community-dwelling people with SCI commonly engage in wheelchair-oriented participation outcomes related to 'community, social, and civil life', 'domestic life' and 'mobility' and tend to be satisfied with their performance of these participation outcomes. This information is useful for clinicians and may help to guide assessment and intervention.

An evaluation of a laser scanning device for the detection of Cryptosporidium parvum in treated water samples.

A laser scanning device, the ChemScan RDI (Chemunex, Paris, France), was compared with manual fluorescence microscopy for the detection of oocysts of Cryptosporidium. Pairs of filters were spiked with approximately 100 oocysts. Over 24 h at least 1000 l of treated water was passed through the filters, then concentrated deposits were subjected to an immunomagnetic separation (IMS) protocol described by the manufacturer (Dynal, Oslo, Norway) and examination by fluorescence microscopy, or an IMS protocol (Chemunex) and detection by ChemScan laser scanning. Subsequently a set of five 1-ml samples containing oocysts over a range of concentrations, including a negative control, were examined blind by the two methods (stage two). In stage 1 the average recovery rates were estimated to be 49% (manual fluorescence microscopy) and 73% (ChemScan). The average ratio of ChemScan to manual fluorescence microscopy counts was 1.54 (range 1.08-2.36). In stage 2, statistical comparison of all but one set of results showed there was no significant difference between methods. Differences for the high count sample may possibly have been caused by duplicate counting of oocysts by manual fluorescence microscopy.

Newborn infant with inherited ring and de novo interstitial deletion on homologous chromosome 22s.

A 2-day-old infant was evaluated and suspected of having 22q11.2 deletion based on microcephaly, short and narrow palpebral fissures, a prominent nose with hypoplastic alae nasi, thin fingers, and a right aortic arch. He also had an imperforate anus, which is not in the del 22q11.2 syndrome. Karyotype analysis identified a ring 22, while fluorescence in situ hybridization (FISH) for the DiGeorge syndrome critical region identified a 22q deletion on the other homologue. The karyotype designation was 46,XY,r(22)(p13q13.3).ish del(22)(q11.2q11.2) (D22S75-). Both parents function in the mildly mentally retarded range. The father's karyotype was normal whereas the mother had the ring 22 that was inherited by her son. This is the first case reported for abnormalities on both 22 homologues.

The WRKY superfamily of plant transcription factors.

The WRKY proteins are a superfamily of transcription factors with up to 100 representatives in Arabidopsis. Family members appear to be involved in the regulation of various physio-logical programs that are unique to plants, including pathogen defense, senescence and trichome development. In spite of the strong conservation of their DNA-binding domain, the overall structures of WRKY proteins are highly divergent and can be categorized into distinct groups, which might reflect their different functions.

Early nuclear events in plant defence signalling: rapid gene activation by WRKY transcription factors.

Parsley WRKY proteins comprise a family of plant-specific zinc-finger-type factors implicated in the regulation of genes associated with pathogen defence. In vitro, these proteins bind specifically to functionally defined TGAC-containing W box promoter elements within the Pathogenesis-Related Class10 (PR-10) genes. Here we present in vivo data demonstrating that WRKY1 is a transcriptional activator mediating fungal elicitor-induced gene expression by binding to W box elements. In situ RNA hybridization revealed that the WRKY1 gene is rapidly and locally activated in parsley leaf tissue around fungal infection sites. Transient expression studies in parsley protoplasts showed that a specific arrangement of W box elements in the WRKY1 promoter itself is necessary and sufficient for early activation and that WRKY1 binds to such elements. Our results demonstrate that WRKY transcription factors play an important role in the regulation of early defence-response genes including regulation of WRKY1.

An undergraduate oncology nursing course.

PURPOSE/OBJECTIVES: To develop an undergraduate oncology nursing course that provides deeper, more structured education in cancer care. DATA SOURCES: Oncology Nursing Society and American Cancer Society materials, current oncology nursing texts, and published periodical literature. DATA SYNTHESIS: An undergraduate oncology nursing course was designed and successfully conducted that included clinical experience in the inpatient, outpatient, and home environments with experience in dealing with as many aspects of patient care as possible. CONCLUSIONS: An oncology nursing course taught by expert practitioners and mentors can and should be offered annually to undergraduate nursing students. IMPLICATIONS FOR NURSING PRACTICE: Improved oncology patient care should result when nurses caring for patients with cancer receive specific information and specialized clinical experience as students that they can apply upon program completion as healthcare providers in the community.

Patient and caregiver perceptions of cancer pain control.

OBJECTIVES: This study measured the perceptions of cancer patients and caregivers in Utah concerning knowledge about and adequacy of pharmacologic cancer pain control. MATERIALS AND METHODS: A descriptive survey was sent to a stratified random sample of adult cancer patients obtained from the Utah Tumor Registry. Questionnaires asked cancer patients and caregivers about their knowledge of pain control and about perceptions of the adequacy of pharmacologic cancer pain management. RESULTS: The study had a 52% response rate (259 of 500) after two mailings. Eighty-five percent (219 of 259) of the respondents stated that they had no cancer pain. With the first mailing, a "no pain" response was not offered as an option. When the researchers realized that this might be a possible response, a second mailing was sent, which may be the reason for the high response rate. CONCLUSIONS: Cancer literature indicates that much cancer pain is not effectively controlled. The majority of the respondents of this study reported no pain. Because this result is different than that reported in the literature, it may indicate that education of healthcare providers, patients, and families can improve cancer pain management and control. It may also indicate an inability of the study to obtain data from those patients having cancer pain. This study should be repeated with a focused population of advanced stage cancer patients with types of cancer typically producing high levels of cancer pain.

Teaching cancer principles to undergraduate students.

Cancer is the second leading cause of death in the United States. Most of the United States population will have some exposure to cancer during their lifetime. Medical knowledge becomes more advanced daily. Rapidly expanding knowledge specific to cancer etiology, diagnosis, and treatment is no exception. The consumer is at risk of misunderstanding this information at the time of the crisis because of the emotional, physical, and financial involvement. Gaining knowledge about cancer prior to such involvement may allow a better understanding if cancer care is required in the future. The Honors Oncology Course titled Learning to Live with Cancer was developed at the College of Nursing at Brigham Young University. It was developed to teach nursing and non-nursing students basic cancer principles, provide information regarding diagnosis and treatment of the disease, and allow students to work with cancer patients in the community to understand the impact of cancer on the patients, families, significant others, and the community at large.

DNase1 footprints suggest the involvement of at least three types of transcription factors in the regulation of alpha-Amy2/A by gibberellin.

To elucidate the mechanisms by which alpha-amylase genes are expressed in wild oat aleurone, two genes, alpha-Amy2/A and alpha-Amy2/D, were isolated. Both were shown to be positively regulated by gibberellin (GA) during germination and both contain the conserved cis-acting elements Box 2, GA-response element (TAACAGA) and TATCSATSS (where S is C or G). In addition, they possess a conserved initiator element (CATCA) that is present in both alpha-Amy2 and alpha-Amy1 genes, and also in a number of other plant TATA-containing and TATA-less promoters. DNase 1 footprint analysis showed the alpha-Amy2/A promoter to be a complex array of binding sites for a number of different classes of DNA-binding proteins. Our data suggest that the area around the initiator element (Inr) is bound by a large complex of general transcription factors, that the TATA box is bound by the TFIID complex, that Box 2 is bound by one or more WRKY proteins and that the GA-response element is bound by one or more MYBs. Two other elements containing the core sequence CCATGG/C are bound by nuclear protein and this sequence is the core of the Sph element. The regulation of alpha-Amy2 genes by GA therefore involves an interplay of at least three different types of transcription factor.

Transcriptional control of plant genes responsive to pathogens.

Transcriptional activation of genes is a vital part of the plants defence system against pathogens. Cis-acting elements within the promoters of many of these genes have recently been defined and investigators have started to isolate their cognate trans-acting factors. Some of these factors have counterparts in animals, whereas others are present only in plants, reflecting the fact that plants have developed a unique defence system.