Raising awareness of pre-conception care in community pharmacies: a feasibility study.

BACKGROUND: There is growing evidence to support the introduction of pre-conception interventions to optimise the health of mothers and their future children. At present, there is poor awareness regarding the importance of pre-conception care (PCC) amongst healthcare professionals and couples planning a pregnancy. Community pharmacies are ideally placed to reach a range of prospective couples planning a pregnancy and could effectively provide information about PCC. METHODS: This study assessed feasibility of an intervention to raise awareness of PCC in community pharmacies in Northern Ireland over 3 months. INCLUSION CRITERIA: women of childbearing age (16-45 years) engaging with services at participating pharmacies. Study resources: campaign posters, information cards, crib sheets for pharmacy staff. A mixed methods approach was employed, including, brief information provision for women, record of staff interactions with customers, customer feedback cards and qualitative interviews with pharmacy staff. Descriptive statistics assessed distribution of study resources and staff interviews were analysed using a thematic analysis framework. RESULTS: There were eight participating pharmacies, three of which consented to post-study interviews. Three pharmacies chose not to deliver the planned intervention. Distribution of campaign cards (n = 456) varied (0-86%). Analysis of customer feedback cards (n = 9) demonstrated that the majority of respondents were happy to receive information on pre-conception health. Of the women who responded to this question (n = 8), all were 'extremely likely' or 'likely' to act on the information provided. Four main themes emerged from analysis of staff interviews: (1) training and experience in providing health advice, (2) intervention resources, (3) understanding the aims of the intervention, (4) perceived value of the intervention. Barriers to intervention delivery included non-engagement from pharmacies and need for additional training of staff. CONCLUSIONS: An intervention to raise awareness of PCC within a community pharmacy setting was feasible and acceptable to both women and staff in participating pharmacies. This study indicates that a number of factors must be considered to enhance implementation and effectiveness of PCC interventions in this setting. In particular, better understanding of non-engagement, provision of adequate training and support for staff, and exploring incentives for pharmacies to prioritise PCC.

Comparison of limb kinematics between collected and lengthened (medium/extended) trot in two groups of dressage horses on two different surfaces.

BACKGROUND: Dressage horses are often asked to work in lengthened paces during training and competition, but to date there is limited information about the biomechanics of dressage-specific paces. Preliminary work has shown increased fetlock extension in extended compared with collected paces, but further investigation of the kinematic differences between collected, medium and extended trot in dressage horses is warranted. OBJECTIVES: Investigation of the effect of collected vs. medium/extended trot on limb kinematics of dressage horses. STUDY DESIGN: Prospective kinematic evaluation. METHODS: Twenty clinically sound horses in active dressage training were used. Group 1: Ten young horses (≤6 years) were assessed at collected and medium trot and Group 2: Ten mature horses (≥9 years) were assessed at collected and extended trot. All horses were evaluated on two different surfaces. High speed motion capture (240 Hz) was used to determine kinematic variables. Fore- and hindlimb angles were measured at mid-stance. Descriptive statistics and mixed effect multilevel regression analyses were performed. RESULTS: Speed and stride length were reduced and stride duration increased at collected compared with medium/extended trot. Lengthened trot (medium/extended trot) was associated with increased fetlock extension in both the fore- and hindlimbs in both groups of horses. Changes were greater in mature horses compared with young horses. Shoulder and carpus angles were associated with forelimb fetlock angle. Hock angle was not significantly influenced by pace. Surface had no effect on fetlock or hock angles. MAIN LIMITATIONS: Only 2D motion analysis was carried out. Results may have differed in horses with more extreme gait characteristics. CONCLUSIONS: Medium/extended trot increases extension of the fore- and hindlimb fetlock joints compared with collected trot in both young and mature dressage horses, respectively.

Effect of superficial harrowing on surface properties of sand with rubber and waxed-sand with fibre riding arena surfaces: a preliminary study.

A recent epidemiological study identified various aspects of arena surfaces and arena surface maintenance that were related to risk of injury in horses and that arena maintenance is important in reducing injury risk. However, there has been little research into how properties of arena surfaces change with harrowing. This study aimed to compare the properties of different arena surface types pre- and post-harrowing. The Orono Biomechanical Surface Tester fitted with accelerometers and a single- and a three-axis load cell was used to test 11 arenas with two different surfaces types, sand with rubber (SR) and waxed-sand with fibre (WSF). Three drop tests were carried out at 10 standardised locations on each arena. Mixed models were created to assess the effect of surface type, pre- or post-harrowing, and drop number on the properties of the surface, including maximum horizontal deceleration, maximum vertical deceleration, maximum vertical load and maximum horizontal load. Post-harrowing, none of the parameters were altered significantly on SR. On WSF, maximum vertical deceleration and maximum vertical load significantly decreased post-harrowing. The differences in the effects of superficial harrowing on SR and WSF could be attributed to the different compositions and sizes of the surface material. The results suggest that different maintenance techniques may be more suitable for different surface types and that the effects of superficial harrowing are short-lived due to the rapid re-compaction of the surface with repeated drops on WSF. Further work is required to determine the effects of other maintenance techniques, and on other surface types.

Effect of a Pessoa training aid on temporal, linear and angular variables of the working trot.

Development of core muscle strength is important for training and during rehabilitation following injury. A Pessoa training aid (PTA) is a system of ropes and pulleys which is commonly used during equine training and rehabilitation, but there is limited information on its effectiveness. The objective of the study was to determine the effect of the PTA on the temporal, linear and angular kinematics of the working trot. Influence of testing order on effect of a PTA was assessed in four horses. Twelve riding horses were lunged at working trot on a 16 m diameter circle without (WO) and with a PTA (WP) that was set level with the shoulder. Objective measurements were carried out using high-speed motion capture (125 Hz) and inertial measurement units. Subjective video assessment was also undertaken. When a PTA was applied there was a significant reduction in speed, stride length, head angle (P<0.0001 for all) and lumbosacral angle at maximal hindlimb retraction (P=0.0028), but no effect on limb joint angles. The highest point of the horse was significantly different between conditions (WO, poll; WP, crest) (P=0.0010). Dorsoventral displacement of the middle of the back (P≤0.0001) and overall impression grade (P=0.0002) were significantly greater WP compared with WO. These findings indicated that a PTA may be beneficial for general training and rehabilitation as a method of improving posture, stimulating core muscle activation and improving overall way of going, without increasing the loading of forelimb and hindlimb structures. Further work is warranted to understand the mechanism which induces these changes.

The effect of collection and extension on tarsal flexion and fetlock extension at trot.

A recent epidemiological study indicated that various factors may be related to injury in dressage horses, but the mechanism by which these injuries occur has yet to be determined. The suspensory ligament (SL) is a frequent site of injury, and it is assumed that greatest strain is placed on this structure in collected trot; this has yet to be proved conclusively. The study aimed to investigate the effect of collected and extended trot on the hindlimb movement pattern. Four dressage horses were fitted with markers and inertial motion sensors (IMS). High-speed video was obtained for 2 strides on each rein in collected and extended trot on 3 different surfaces: waxed outdoor; sand/plastic granules; and waxed indoor. Maximal tarsal flexion during stance and distal metatarsal coronary band ratio (MTCR), representing fetlock extension, were determined. Inertial motion sensor data determined stride duration, speed and stride length. Data were compared between collection and extension within horses on each surface, and compared between surfaces. Collected trot had significantly lower speed and stride length but longer stride duration than extended trot on all surfaces. All horses had less tarsal flexion and fetlock extension in collected compared with extended trot (P<0.05), which is likely to increase SL loading. The study findings indicate that extended trot may increase SL strain, providing a possible explanation for the high incidence of SL injury in horses trained for extravagant movement. It is possible that substantial use of extended trot could be a risk factor for development of suspensory desmitis, which might be one contributory factor in the prevalence of suspensory desmitis in young horses repeatedly undertaking extravagant movement.

One tone, two ears, three dimensions: a robotic investigation of pinnae movements used by rhinolophid and hipposiderid bats.

Bats, which echolocate using broadband calls, are believed to employ the passive acoustic filtering properties of the head and pinnae to provide spectral cues which encode 3-D target angle. Microchiropteran species whose calls consist of a single, constant frequency harmonic (i.e., some species in the families Rhinolophidae and Hipposideridae) may create additional acoustic localization cues via vigorous pinna movements. In this work, two types of echolocation cues generated by moving a pair of receivers aboard a model sensor head are investigated. In the first case, it is supposed that a common 3-D echolocation principle employed by all bats is the creation of alternative viewing perspectives, and that constant frequency (CF) echolocators use pinna movement rather than morphology to alter the acoustic axes of their perceptual systems. Alternatively, it is possible rhinolophids and hipposiderids move their ears to create dynamic cues--in the form of frequency and amplitude modulations--which vary systematically with target elevation. Here the use of binaural and monaural timing cues derived from amplitude modulated echo envelopes are investigated. In this case, pinna mobility provides an echolocator with a mechanism for creating dramatic temporal cues for directional sensing which, unlike interaural timing differences, do not degrade with head size.

Intra-arterial chemotherapy in patients with breast cancer: a feasibility study.

The aim of this study was to assess the practicality of treating patients with various stages of breast cancer by means of regional (intra-arterial) chemotherapy. Three groups of patients received a median of four (range 2-4) cycles of combination chemotherapy: group I operable primary (n = 10); group II, locally advanced disease (n = 20); group III, recurrent locoregional disease (n = 22). The response rates (complete response, partial response and mixed response) in these groups of patients were 100% in groups I and II and 86% in group III. Morbidity included drug streaming and dysaesthesia in the hand. Patients in groups I and II had their tumours downstaged, allowing surgery to be performed. Local control was also achieved in group III when other treatment modalities had failed.

An improved nipple prosthesis.

A nipple-areola reconstruction of prosthesis completes the process of breast reconstruction. Reconstructions are technically difficult and have poor long-term results, whereas commercial nipple prostheses are unsatisfactory in matching the normal colour and shape. We describe a simple technique for the manufacture of a custom made nipple-areola prosthesis.

Physiological adaptation to the environment.

The ability of an animal to cope with new environments arises from its capacity to respond to environmental variables and maintain body equilibrium (homeostasis). Each compensating mechanism depends on, and is a part of, a physiological feedback process. The severity (intensity and duration) of an environmental change relative to the animal's capacity to respond determines the potential disruption to the animal's equilibrium and the resources that must be invested to regain homeostasis. However, an environmental change sufficient to seriously challenge one individual may be insufficient to produce a measurable response in another. The principles behind the responses occurring in animals as a consequence of a change in their physical environment are illustrated in this review by examples drawn from responses of animals to cold stress. Behavioral opportunities sometimes are constrained in farm animals, and internal metabolic responses tend to become more prominent in such situations. Furthermore, as a disturbing factor persists, the immediate defensive responses are replaced by longer-term and adaptive mechanisms that reduce the burden on the animal. As we gain greater understanding of the environment-animal interface and the sensitivity and response of animals to disruption, we will be better able to establish and maintain suitable environments for our farm animals.

Relative bioavailability of controlled release morphine tablets (MST continus) in cancer patients.

The bioavailability of oral controlled release morphine tablets (MST, Napp Laboratories) and oral morphine sulphate in aqueous solution (MSS) was compared in 10 patients with advanced cancer. Serum samples were analysed for morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) using a specific HPLC assay. The relative bioavailability of morphine with MST was significantly less than that with MSS (mean 80%, range 50-110%) although there was no difference between the formulations in the relative availability of M3G and M6G. There was no significant difference between the formulations in the serum concentration of morphine at 12 h. The mean ratios morphine: M6G:M3G (comparing areas under the serum concentration-time curves) were 1:9:56. There was a highly significant linear relationship between the dose administered and AUC for morphine, M3G and M6G after MSS; and for morphine after MST. Median tmax for morphine was 0.5 h with MSS and 2.5 h with MST; for M3G 1.5 h with MSS and 3.0 h with MST; and for M6G 1.5 h with MSS and 3.25 h with MST. A secondary peak of unconjugated morphine, which may represent enterohepatic circulation, was seen in several patients 2-4 h after administration of elixir and 4-6 h after administration of MST.