A robust and functional CRISPRcrRNA testing method for soy bean cultivar modifying using LbCpf1 ribonucleoproteins

Style Possible, single-blinded, randomised governed demo. Environment Outpatients. PARTICIPANTS Fifty-one sufferers together with Parkinson's ailment have been given arbitrarily to some VR rehabilitation program or even a typical rehabilitation system. Treatments The two programmes happened to run for six successive several weeks, with a 40-minute treatment three times weekly. MAIN Result MEASURES The Balance Berg Size (BBS) was used to measure balance Epigenetics inhibitor . Second final result procedures ended up Powerful Walking List (DGI) to gauge power to adapt gait to complicated walking jobs; Disabilities with the Provide, Make and also Hand (DASH) range to determine functionality from the higher limb; along with Small Variety 36 (SF-36) to guage total well being. Benefits Your VR rehab system resulted in an increase in BBS rating 45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence intBACKGROUND Splinting is recommended by various organisations as a non-surgical first-line treatment for carpal tunnel syndrome (CTS), despite the limited evidence supporting its effectiveness. Previous studies on the effectiveness of low-level laser therapy (LLLT) have reported mixed results, and this systematic review aimed to resolve this controversy. OBJECTIVE To perform a network meta-analysis (NMA) for evaluating the effectiveness of LLLT compared with other conservative treatments for CTS. METHODS Eighteen electronic databases were searched for potential randomised controlled trials (RCTs). RCTs evaluating LLLT or other non-surgical treatments as an add-on to splinting were included. Included RCTs measured at least one of the following three outcomes with validated instruments pain, symptom severity and functional status. RESULTS Six RCTs (418 patients) were included. NMA suggested that LLLT plus splinting has the highest probability (75%) of pain reduction, compared with sham laser plus splinting (61%)OBJECTIVES Sham-controlled trials of dry needling, a popular treatment for pain, use a range of methods and theoretical frameworks and most have high risk of bias. Critically, patient blinding is often unsuccessful and therapist blinding has not been attempted. The specific effects of dry needling on pain therefore remain unclear. Our objectives were to identify (1) important elements of active dry needling; (2) important elements of shams for dry needling. DESIGN AND PARTICIPANTS Two Delphi surveys (to quantify levels of consensus) were undertaken with three expert groups experts in (1) dry needling, (2) research methodology, and (3) deceptive/hypnotic techniques including magic. Experts in dry needling participated in Delphi 1 and all three groups participated in Delphi 2. Each survey commenced with an open-ended question. Responses were converted to single 'items' suitable for rating on 9-point Likert scales [categorised as 'Not important' (0-3), Depends (4-6), and Essential (7-9)], which participants rateBACKGROUND Total hip (THR) and knee replacement (TKR) are two of the most common elective orthopaedic procedures worldwide. Physiotherapy is core to the recovery of people following joint replacement. However, there remains uncertainty as to physiotherapy provision at a national level. OBJECTIVES To examine the relationship between patient impairment and geographical variation on the provision of physiotherapy among patients who undergo primary total hip or knee replacement (THR/TKR). DESIGN Population-based observational cohort study. METHODS Patients undergoing THR (n=17,338) or TKR (n=20,260) recorded in the National Joint Registry for England (NJR) between 2009 and 2010 and completed Patient Reported Outcome Measures (PROMs) questionnaires at Baseline and 12 months postoperatively. Data were analysed on the frequency of physiotherapy over the first postoperative year across England's Strategic Health Authorities (SHAs). Logistic regression analyses examined the relationship between a range of patient and BACKGROUND Parkinson's is a common progressive neurological condition characterised by impairments of movement and balance; and non-motor deficits. It is now accepted that physical activity is a fundamental for people with Parkinson's (PwP), despite this PwP remain inactive. There is a social and financial drive to increase physical activity for PwP through physical self-management, however little is known about this concept. OBJECTIVE This scoping review provides an overview of the literature concerning physical self-management for PwP and its provision, participation and uptake by PwP. DESIGN AND SOURCES OF EVIDENCE Systematic search of the databases; Medline, EMBASE, HMIC, CDSR, Cochrane Methods Studies, DARE, CINAHL, PEDro, PsycINFO and Cochrane Library using the search terms 'Parkinson*' and 'self-manag*' was undertaken alongside citation and grey literature searching and a consultation exercise. CHARTING METHODS A narrative summary was undertaken to describe the current state of the literature. RESULTS OBJECTIVE To compare the effects of different cryotherapeutic preparations. DESIGN Randomised, single-blind, crossover trial. SETTING University laboratory. PARTICIPANTS Sixteen healthy women. INTERVENTIONS Participants were randomised to receive three cryotherapeutic preparations pure ice (500g), watered ice (500g of ice in 500ml of water) and wetted ice (500g of ice in 50ml of water). MAIN OUTCOME MEASURES The primary outcome was skin surface temperature after cryotherapy, measured at the central point of application, and the minimum temperature of the region of interest (ROI). The secondary outcome was the surface area cooled to less then 13.6°C, which is the recommended temperature to achieve therapeutic effects. RESULTS After application of ice, mean skin surface temperature at the central point was 4.6 [standard deviation (SD) 1.9] °C for the pure ice preparation, 4.9 (SD 2.5) °C for the wetted ice preparation, and 9.6 (SD 1.8) °C for the watered ice preparation. When compared with the watered ice prepOBJECTIVE To investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone, in individuals with chronic non-specific low back pain (CNLBP). DESIGN Randomized controlled trial with three months follow-up. SETTING Rehabilitation clinic. PARTICIPANTS Seventy-two individuals (between 18 and 50 years of age; CNLBP ≥12 consecutive weeks) were enrolled and randomly allocated to one of two groups (1) Spinal manipulation and myofascial release - SMMRG; n=36) or (2) Spinal manipulation alone (SMG; n=36). INTERVENTIONS Combined spinal manipulation (characterized by high velocity/low amplitude thrusts) of the sacroiliac and lumbar spine and myofascial release of lumbar and sacroiliac muscles vs manipulation of the sacroiliac and lumbar spine alone, twice a week, for three weeks. MAIN OUTCOME MEASURES Assessments were performed at baseline, three weeks post intervention and three months follow-up. Primary outcomes were pain intensity and disability. SecondaryHealth care provision is changing, and so is the information we use to guide decisions related to patient care. Increasingly, health practitioners will need to deal with genetics and 'big data' in the context of clinical practice. Indeed, commercial packages for consumer genetic testing are already widely available, and devices enabling self-monitoring of health are in daily use by many of our patients. "Precision health" (distinct from "precision medicine") provides a model, which allows us to bring our genome together with our external environment (lifestyles, societal influences etc.) and eventually, our transient internal environment (reflected by 'omics'), to optimise disease prevention and care. Such advancements have given rise to a need for primary health care clinicians to understand basic genetic and precision health concepts. This editorial meets this need, serving as a primer by providing the following an introduction to current primary health challenges; description of the key elements of the preOBJECTIVE To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN Randomised clinical trial. SETTING University-based, outpatient, physical therapy clinic. SUBJECTS Fifty individuals with COPD. INTERVENTIONS Participants were assigned at random to the land group (LG; n=27) or the water group (WG; n=23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS Seventeen subjects completed the intervention in the LG nine mOBJECTIVES Maintaining physical activity for older residents in care homes maximises their physical and mental health and wellbeing, independence, dignity and quality of life. Unfortunately, most residents do not participate in regular physical activity. Active Residents in Care Homes, ARCH, was designed to increase physical activity by facilitating whole-system change in a care home. We evaluated whether ARCH can be delivered, its effects on resident's physical activity, wellbeing and costs. DESIGN Feasibility study. SETTING Three residential care homes. PARTICIPANTS Care home residents and staff. INTERVENTION Occupational and physiotherapists implemented ARCH over 4 months with an 8-month follow-up. MAIN OUTCOME MEASURES Assessment of Physical Activity, Pool Activity Level, EQ5D-5L, Dementia Care Mapping, cost of implementing ARCH, health and social care utilisation. RESULTS After implementing ARCH, residents displayed more positive behaviours, better mood and engagement and higher physical activity levels,Shared decision making is integral to high-quality, evidence-based, and patient-centred physiotherapy practice. It involves therapists and patients collaboratively making a health-related decision after having discussed the options, the likely benefits and harms of each option, and considered the patient's values, preferences and circumstances. Despite being a crucial part of the final step in evidence-based practice, the skills needed to facilitate shared decision making are rarely taught to physiotherapists. This Debate article explores the reasons for the importance of shared decision making to physiotherapy practice; its fundamental role in improving therapist-patient communication, informed decision-making, and evidence-based care; and illustrates some of the processes involved using clinical scenarios. Copyright © 2019 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.BACKGROUND Stroke survivors do not have routine access to objective feedback on their movement performance. OBJECTIVE To devise visual representation of objective measures of movement performance that are understandable by and meaningful to stroke survivors. DESIGN Co-production through interviews and generative discussion. PARTICIPANTS Eight people, mean age 65 years, who were at least one year after stroke with low, medium or high functional ability. All provided informed consent. DATA COLLECTION Participants performed standardised upper and lower limb functional tasks. Their movement was measured using the Vicon motion analysis system and surface electromyography. Participants returned six months later when they were shown anonymised visual representations of the movement tasks. Nobody saw their own data. Visual representations were provided of people with low, medium and high functional ability. A generative discussion elicited participants' views on how the measures should be presented visually to maximiBACKGROUND People with persistent pain from culturally and linguistically diverse (CALD) communities experience significant health inequities. OBJECTIVE To synthesise the sociocultural factors influencing pain management between CALD patients with persistent pain and physiotherapists treating CALD patients. DATA SOURCES Major electronic databases MEDLINE, AMED, Scopus, Web of Science, PsycINFO and Google Scholar were searched until July 2018. STUDY SELECTION Studies were included if they explored clinical interactions between physiotherapists and patients with persistent pain from diverse ethnocultural backgrounds. STUDY APPRAISAL The methodological quality of qualitative and quantitative studies were assessed using the Critical Appraisal Skills Programme (CASP) Checklist and Mixed Methods Appraisal Tool (MMAT) respectively. SYNTHESIS METHOD A thematic synthesis approach was used to extract the common themes. RESULTS Sixteen articles from 16 studies were included. Eleven studies were qualitative and five studOBJECTIVES Conduct an elicitation study, using the Theory of Planned Behaviour framework, to identify salient beliefs about exercise participation in adults with cystic fibrosis (CF). Specifically, identify attitudes on advantages and disadvantages of exercise (behavioural beliefs); individuals and groups who apply social pressure to exercise (normative beliefs); and perceived control over facilitators and barriers to exercise (control beliefs) for adults with CF. DESIGN Qualitative interviews using open-ended, structured questions. SETTING Adult CF clinic in a large Australian hospital. PARTICIPANTS Sixteen adults with CF, three relatives/friends of adults with CF and six CF clinic staff. RESULTS The most common positive attitudes about exercise were to keep fit and healthy (68%) and feel better and happier (60%), and negative attitude was to feel breathless (36%). Social pressure to exercise mainly came from parents/family (72%) and friends (52%), and 60% of participants reported that no-one discourages exeOBJECTIVES To determine the minimal important difference (MID) for the London Chest Activity of Daily Living scale (LCADL) in patients with chronic obstructive pulmonary disease (COPD), focusing on the percentage of the total score (LCADL%total), using an anchor-based method in addition to distribution-based methods. DESIGN Non-controlled before-and-after study. SETTING Two outpatient centres. PARTICIPANTS Seventy-seven patients with COPD (GOLD II-IV, 47 males, forced expiratory volume in 1second mean 37 (SD 14) % predicted). INTERVENTIONS Aerobic training and localised training for upper and lower limbs was conducted for 24 sessions, three times per week. MAIN OUTCOME MEASURES The main outcome was LCADL score pre- and post-exercise training. The MID was established using distribution and anchor-based methods. The modified Saint George Respiratory Questionnaire was the anchor for the analysis of sensitivity and specificity of the MID. RESULTS The established MIDs ranged from -2.1 to -5.9 points for LCADLtotalOBJECTIVES To explore the feasibility of delivering and evaluating a web-based walking intervention for people with long term musculoskeletal conditions (LTMCs), to determine its acceptability and the feasibility of conducting a definitive trial. DESIGN Prospective randomised feasibility study, with blind outcome assessment at baseline, 3 and 6 months. SETTING Hospital based physiotherapy service. PARTICIPANTS Forty one adults referred for assessment and advice for any mild/moderate LTMCs. doing less then 120minutes of moderate intensity activity per week. INTERVENTIONS Participants randomised to 1. Usual care one usual physiotherapy advice and assessment session, including setting a physical activity goal and one follow up session (8 weeks). 2. "Walk30×5" session one, usual care plus intervention of walking programme. Participants were shown the website and podcasts and practiced how to use them. One follow up session (8 weeks). OUTCOME MEASURES Primary timed six minute walk test (T6MWT). Secondary step couOBJECTIVES Gait disturbance and impaired balance lead to a greater risk of falls and hip fractures for people with dementia. Physiotherapists play an important role in multidisciplinary dementia care. This study aimed to explore physiotherapists' experiences of dementia care and sought to identify their dementia-specific educational needs. DESIGN Qualitative design, using focus group interviews. SETTING Primary care and secondary care physiotherapy services in the Republic of Ireland. PARTICIPANTS Six focus groups with thirty-two physiotherapists, working in community care and hospital settings. RESULTS Physiotherapists described a significant dementia-related workload. Challenges to care included absence of a formal diagnosis, clinical uncertainty, scarcity of resources, physical working environment and the assessment of rehabilitation potential. Dementia care was enhanced by the involvement of family members and by collaboration with other allied healthcare professionals. Participants expressed a wish to reOBJECTIVES The Getting it Right Addressing Shoulder Pain (GRASP) trial is a large-scale, multicentre, 2×2 factorial randomised controlled trial investigating clinical and cost-effectiveness of a progressive exercise programme versus best-practice advice, with or without corticosteroid injection, for treating people with rotator cuff disorders. Here we describe the development, implementation and details of the physiotherapy-led interventions. METHODS Medical Research Council guidance for developing complex interventions were used, taking into account clinical guidelines, expert and patient opinion, research evidence, current practice variation, and deliverability. A stakeholder meeting of 26 experts, clinicians, researchers, and patient representatives was used to design key components of the interventions. Stakeholders prioritised strengthening posterior rotator cuff muscles and using practical, easy-to-do exercises. The interventions were designed to be deliverable across the UK National Health Service. RESOBJECTIVE To evaluate the impact of combining nebulised hyaluronic acid plus hypertonic saline (HA+HS) with oscillatory positive expiratory pressure (oscillatory-PEP) on sputum expectoration and related symptoms in adults with cystic fibrosis (CF). DESIGN Randomised crossover trial. SETTING Seven centres. PARTICIPANTS Twenty-two outpatients with CF. INTERVENTIONS Usual care (HA+HS followed by autogenic drainage) and combined therapy (HA+HS with oscillatory-PEP followed by autogenic drainage]. Each treatment was performed for 5 days. MAIN OUTCOME MEASURES Sputum expectoration was measured during the nebulisation period (primary outcome), during autogenic drainage and for 24hours post intervention. The Cough and Sputum Assessment Questionnaire (CASA-Q) and its domains (cough symptoms, cough impact, sputum symptoms and sputum impact), the Leicester Cough Questionnaire (LCQ) and lung function tests were used. Tolerance and patient preference were registered. RESULTS Twenty-two participants [mean age 25 (standard OBJECTIVES Does adapted cardiac rehabilitation (CR) improve the physical behaviours of people with mild-to-moderate stroke in the sub-acute recovery phase using a compositional data analysis (CoDA) approach? DESIGN Before-after. SETTING University Hospitals of Leicester, Glenfield Hospital, UK. PARTICIPANTS 24 individuals completed CR and provided valid physical activity (PA) data (mean (SD) 63.1 (14.6) years, 58% male (14/24)). INTERVENTION 6-week adapted CR program within 6-months of stroke. MAIN OUTCOME MEASURES Physical behaviours were assessed using waist-worn accelerometry. Step count, stationary time (ST), light PA (LPA), and moderate-to-vigorous PA (MVPA) were compared pre post CR using conventional analyses and CoDA. Analysed compositions were Waking day (ST, LPA, MVPA); ST (1-9-minutes, 10-29-minutes, ≥30-minutes bouts); and MVPA (1-4-minutes, 5-9-minutes, ≥10-minutes bouts). RESULTS Following CR, patients took significantly more steps (mean (SD) 3255 (2864) vs 3908 (3399) steps/day, P=0.004) and enBACKGROUND OR CONTEXT Routine imaging for non-specific low back pain is advised against in guidelines yet imaging continues to occur. Patient and public beliefs regarding imaging may be a driving factor contributing to this. OBJECTIVES To review the current evidence in relation to patient and public beliefs regarding imaging for low back pain. DATA SOURCES A systematic scoping review was conducted in databases Medline, Embase, Cinahl, Psyc info (inception - Jan 2018). STUDY SELECTION Any method of study including beliefs of adults about imaging for non-specific low back pain. DATA EXTRACTION AND DATA SYNTHESIS Descriptive data was extracted and patient and public beliefs about imaging for low back pain was analysed using conventional qualitative content analysis. RESULTS 12 studies from an initial search finding of 1135 were analysed. 3 main themes emerged; (1) The Desire for imaging; (2) Influences on patient desire for imaging including (a) clinical presentation, (b) past experience and (c)relationships witOBJECTIVES Investigate upper limb (UL) capacity and performance from less then 14-days to 24-months post stroke. DESIGN Longitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke. SETTING Two acute stroke units. MAIN OUTCOME MEASURES Examination of UL capacity using Chedoke McMaster Stroke Assessment (combined arm and hand scores, 0-14), performance using Motor Activity Log (amount of movement and quality of movement, scored 0-5), and grip strength (kg) using Jamar dynamometer. Random effects regression models were performed to explore the change in outcomes at each time point. Routine clinical imaging was used to describe stroke location as cortical, subcortical or mixed. RESULTS Thirty-four participants were enrolled median age 67.7 years (IQR 60.7-76.2), NIHSS 11.5 (IQR 8.5-16), female n=10 (36%). The monthly rate of change for all measures was consistently greatest in the 6-weeks post baseline. On average, significant improvements were obOBJECTIVES The aim of this study was to examine the validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Participants were recruited through 8 National Health Service (NHS) trusts, one school, one university and through organisations that provide services for people with disabilities in England. PARTICIPANTS Sixty-four, ambulatory young people aged 10-19 years with CP [Gross Motor Function Classification System (GMFCS) levels I-III] participated in this study. MAIN OUTCOME MEASURE The IPAQ-SF was administered to participants. Participants were then asked to wear a wGT3X-BT triaxial accelerometer (ActiGraph, Pensacola, FL) for 7 days to objectively assess PA. Time spent in sedentary behaviour, in moderate to vigorous PA (MVPA) and in total PA (TPA) was compared between measures. RESULTS Young people with CP self-reported less time in sedentary behaviour and underestimatOBJECTIVES To evaluate the construct validity of two dexterity measures, the 9-Hole Peg Test (9HPT) and Purdue Pegboard Test (PPT) in people with Parkinson's disease (PD). DESIGN Cross-sectional observational study. SETTING Testing was conducted at the university or in participants' homes. PARTICIPANTS Thirty community dwelling people with mild to moderately severe PD and no major upper limb comorbidities or cognitive impairments. INTERVENTIONS Pegboard tests were administered in the 'on' and 'end-of-dose' phases of participants' PD medication cycles. Participants rated hand function with two self-report questionnaires - the Manual Ability Measure-36 (MAM-36) and a subset of upper limb items from the MDS-UPDRS. To explore construct validity, we compared 'on' phase pegboard scores with normative values for unimpaired men and women and investigated relationships between pegboard scores and hand function questionnaires. RESULTS In the 'on' phase, pegboard scores were poorer than normative values. Differences in OBJECTIVES Determine if outpatient physiotherapy care via telerehabilitation is as effective as in-person physiotherapy care after total hip replacement. DESIGN Randomised, single-blind, controlled, non-inferiority clinical trial. SETTING QEII Jubilee Hospital, Brisbane, Australia. PARTICIPANTS Seventy patients receiving a total hip replacement entered the study, sixty-nine completed the study. INTERVENTIONS The control group (n=35; x¯ age 67; female 60%) received in-person outpatient physiotherapy and a paper-based home exercise programme. The intervention group (n=35; x¯ age 62; female 66%) received remotely delivered telerehabilitation directly into their homes and a technology-based home exercise program using an iPad application. MAIN OUTCOME MEASURES The primary outcome was the quality of life subscale of the Hip disability and Osteoarthritis Outcome Score measured at six weeks post-operatively. Secondary outcomes included objective strength and balance outcomes, self-reported function and satisfaction BACKGROUND Sarcopenia is a progressive and generalised skeletal muscle disorder, and a powerful predictor of adverse health outcomes. Exercise is a widely recommended treatment but consensus about the best approach is lacking. OBJECTIVE To synthesise current systematic review evidence on the effectiveness of exercise in the treatment of sarcopenia to inform clinical practice. DATA SOURCES Five electronic databases were searched (15 November 2018) Cochrane Database of Systematic Reviews; MEDLINE without revisions; EMBASE; Scopus; and Web of Science. STUDY SELECTION OR ELIGIBILITY CRITERIA Systematic reviews and meta-analyses of randomised controlled trials evaluating exercise to treat sarcopenia in adults including sarcopenic outcomes. STUDY APPRAISAL AND SYNTHESIS METHODS Review data were extracted and quality assessed (using the AMSTAR 2) by two independent assessors. Due to a lack of eligible reviews, a narrative synthesis of the evidence was performed. RESULTS Two reviews were identified which included sevBACKGROUND Kinesio tape is an elastic therapeutic tape used for treating sports injuries and various other disorders. A systematic review and network meta-analysis approach was used to synthesise all related evidence on the clinical effectiveness of kinesio taping for the treatment of shoulder pain. METHODS A literature search was performed using 10 major databases. Randomised clinical trials reporting usage of kinesio taping for shoulder pain have been included. Quality and risk of bias were assessed using the Cochrane Collaboration's quality assessment tool. Meta-analysis was conducted to calculate standardised mean differences and corresponding 95% confidence intervals (CI). The corresponding 95% CI of pooled effect size were calculated using a fixed-effects or random-effects model based on the level of heterogeneity. In addition, meta-regression was used to assess the influence of underlying shoulder disease on the efficacy of kinesio taping. RESULTS This systematic review and meta-analysis included 12 stOBJECTIVE Early rehabilitation is assumed to be a crucial intervention to facilitate weaning from mechanical ventilation in critically ill patients and to limit their long-term functional dependence. However, little is known about the physiological load imposed on patients during such interventions. Without the ability to quantify the exercise intensity of rehabilitation interventions it is impossible to establish a clear separation between usual care and intervention groups in randomised controlled trials. This may explain the lack of definitive benefit of rehabilitation in published trials. We sought to characterise the physiological load, measured as oxygen consumption (V˙O2), of the physical activities carried out during rehabilitation interventions in mechanically ventilated participants. DESIGN Observational study. SETTING Single centre medical-surgical university hospital ICU. PARTICIPANTS 26 mechanically ventilated participants ventilated >7 days, able to participate in a rehabilitation program. INTEROBJECTIVES To identify unanswered questions for physiotherapy research and help set and prioritise the top 10 generic research priorities for the UK physiotherapy profession; updating previous clinical condition- specific priorities to include patient and carer perspectives, and reflect changes in physiotherapy practice, service provision and new technologies. DESIGN The James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology was adopted, utilising evidence review, survey and consensus methods. PARTICIPANTS Anyone with experience and/or an interest in UK physiotherapy patients, carers, members of the public, physiotherapists, student physiotherapists, other healthcare professionals, researchers, educators, service providers, commissioners and policy makers. RESULTS Five hundred and ten respondents (50% patients, carers or members of the public) identified 2152 questions (termed "uncertainties"). Sixty-five indicative questions were developed from the uncertainties using peer reviewed thematicOBJECTIVES The United Kingdom Frozen Shoulder Trial (UK FROST) compares stand-alone physiotherapy and two operative procedures, both with post operative rehabilitation, for primary frozen shoulder in secondary care. We developed physiotherapy protocols for UK FROST, incorporating best evidence but recognizing uncertainty and allowing flexibility. METHODS We screened a UK Department of Health systematic review and UK evidence-based guidelines (Hanchard et al., 2012; Maund et al., 2012) for recommendations, and previous surveys of UK physiotherapists (Hanchard et al., 2011, 2013) for strong consensus. We conducted a two-stage, questionnaire-based, modified Delphi survey of shoulder specialist physiotherapists in the UK National Health Service. This required positive, negative or neutral ratings of possible interventions in four clinical contexts (stand-alone physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder; and post operative physiotherapy for, respectively, predomiOBJECTIVES This study aimed to identify very early incidence of hemiplegic shoulder pain within 72hours (HSP), how clinical assessment was related to pain at 8-10 week follow-up and explore current standard therapy/management. DESIGN Observational, prospective. SETTING Teaching hospital hyper-acute and follow-up stroke services. PARTICIPANTS 121 consecutive patients with confirmed cerebral infarct/haemorrhage recruited within 72hours of stroke onset. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Subjective report of pain severity and aggravating factors using numerical rating scales and pain questionnaire (ShoulderQ), shoulder abductor and flexor muscle strength (Oxford MRC Scale), Neer's Test of sub-acromial pain, shoulder subluxation and soft tissue shoulder palpation. RESULTS At initial assessment ( less then 72hours), 35% (42/121) reported HSP. At follow-up (8-10 weeks), 44% (53/121) had pain pain persisted in 32 of the original 42, resolved in 10 and had developed since initial assessment in 21. Pain at folloOBJECTIVES Various modifiable and non-modifiable factors affect functional mobility, but subjective patient-reported and objective performance-based measures are rarely combined in explanatory analyses of functional mobility in people with limb loss. This study determined separate explanatory models for patient-reported function using the Prosthetic Evaluation Questionnaire Mobility Subscale (PEQ-MS), and performance-based 2-Minute Walk Test (2MWT). DESIGN Retrospective cross-sectional observational analysis. SETTING Wellness-walking program. PARTICIPANTS Three hundred five volunteers with lower limb loss participated. Sixty nine percent were men, mean age 56 (15) years. Fifty two percent had vascular amputation causes, 42% had surgical levels above the knee, and 82% had medical comorbidities. Walking levels included limited-household (21%), limited-community (30%), and independent-community (49%). Outcome measures included patient-reported PEQ-MS, Activities-specific Balance Confidence (ABC) and Houghton scaBACKGROUND A potential mechanism of action of manual therapy is the activation of a sympathetic-excitatory response. OBJECTIVE To evaluate the effects of joint mobilisation on changes in clinical manifestations of sympathetic nervous system activity. DATA SOURCES MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PubMed, PEDro, Cochrane Collaboration Trials Register, Cochrane Database of Systematic Reviews and SCOPUS databases. STUDY SELECTION Randomised controlled trials that compared a mobilisation technique applied to the spine or the extremities with a control or placebo. DATA EXTRACTION AND DATA SYNTHESIS Human studies collecting data on skin conductance or skin temperature were used. Data were extracted by two reviewers. Risk of bias was assessed using the Cochrane guidelines, and quality of evidence was assessed using the GRADE approach. Standardised mean differences (SMD) and random effects were calculated. RESULTS Eighteen studies were included in the review and 17 were included in the meta-analysis. The meta-anaOBJECTIVES To explore whether a therapist effect exists in physiotherapists treating patients with shoulder pain and to identify if personality traits of the physiotherapist influences patients outcome. DESIGN Observational cohort study. SETTING Primary care physiotherapy practices. PARTICIPANTS Data on patients with shoulder complaints that started and finished treatment between 2009 and 2012 were derived from the NIVEL Primary Care Database. Personality traits of the physiotherapist were identified using the Big Five Inventory. Data of 2814 patients and 56 physiotherapists were analysed using multi level linear regression. MAIN OUTCOME MEASURE Severity of complaint was measured on a 10-point Likert scale at the start and end of treatment. Change score is used as outcome. RESULTS A therapist effect exists in the rehabilitation of patients with shoulder complaints in a physiotherapy setting; the physiotherapist explained 12% of variance and the personality trait extraversion showed a significant association (OBJECTIVES To examine whether patients, diagnosed with the hypermobility type of the Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), with multidirectional shoulder instability (MDI) have increased humeral head translations compared to healthy controls and to describe the direction of the humeral translations during five exercises. DESIGN Observational study. SETTING Ghent University Hospital. PARTICIPANTS Twenty-seven female patients (aged mean (SD) 35 (13) years) with hEDS/HSD and MDI and 20 female healthy controls (aged 34 (11) years) participated in this study. INTERVENTIONS The acromiohumeral (AHD) and humeralglenoid distance (HGD) were measured using ultrasound during five isometric exercises shoulder external rotation, shoulder extension, shoulder flexion, elbow extension and holding a 2kg dumbbell. MAIN OUTCOME MEASURES Ultrasound measures of the AHD and HGD. RESULTS During isometric shoulder extension, elbow extension and dumbbell loading, patients had a significantly larger chBACKGROUND Water-based exercises have the potential to reduce impairments and walking limitations after stroke. OBJECTIVE To examine the effects of water-based exercises on walking speed, balance, and strength after stroke. DATA SOURCES Eletronic searches on MEDLINE, CINAHL, EMBASE, Cochrane, PsycINFO, and PEDro databases. ELIGIBILITY CRITERIA The review included randomized trials. Participants in the reviewed studies were ambulatory adults, who have had a stroke. The experimental intervention was comprised of water-based exercises. DATA SYNTHESIS Outcome data related to walking speed, balance, and strength were extracted from the eligible trials and combined in meta-analyses. The quality of the included trials was assessed by the PEDro scores and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Thirteen trials involving 464 participants were included. Random-effects meta-analyses provided moderate-quality evidence that A synaptic active zone (AZ) can release multiple vesicles in response to an action potential. This multi-vesicular release (MVR) occurs at most synapses, but its spatiotemporal properties are unknown. Nanoscale-resolution detection of individual release events in hippocampal synapses revealed unprecedented heterogeneity among vesicle release sites within a single AZ, with a gradient of release probability decreasing from AZ center to periphery. Parallel to this organization, MVR events preferentially overlap with uni-vesicular release (UVR) events at sites closer to an AZ center. Pairs of fusion events comprising MVR are also not perfectly synchronized, and the earlier event tends to occur closer to AZ center. The spatial features of release sites and MVR events are similarly tightened by buffering intracellular calcium. These observations revealed a marked heterogeneity of release site properties within individual AZs, which determines the spatiotemporal features of MVR events and is controlled, in part, by STUDY OBJECTIVES Sleep quality and chronic neck pain (NP) are associated. However, the genetic influences on this association have not been explored. This study investigated the genetic and environmental influences on the association between sleep quality and chronic NP. METHODS The sample comprised 2328 individual twins from the Murcia Twin Registry (Spain). A bi-directional co-twin logistic regression analysis was performed (sleep quality assessed as the exposure and chronic NP as the outcome, and vice-versa). Analysis included two sequential stages total sample analysis and within-pair twin case-control analysis. RESULTS Sleep quality was significantly associated with chronic NP in the total sample analysis (Adjusted OR 1.09; 95% CI 1.06, 1.12; P less then 0.001), in the co-twin case-control analysis including both monozygotic and dizygotic twin pairs (Adjusted OR 1.10; 95% CI 1.04, 1.17; P= 0.001), in dizygotic pairs (Adjusted OR 1.11; 95% CI 1.03, 1.19; P= 0.005), but not in monozygotic pairs (Adjusted INTRODUCTION Hypoglossal nerve stimulation (HNS) is a novel therapy in the treatment of obstructive sleep apnea (OSA). Previous studies have focused on the effectiveness of HNS, but there are no studies specifically investigating the long-term changes of the stimulation intensities in HNS. Increasing stimulation intensity requirements have been reported in the past in other peripheral nerve stimulation therapies. The aim of this study was to investigate the development of stimulation intensities over the observation period of four years. METHODS All patients who were implanted with a HNS system since December 2013 and maintained a bipolar configuration over the observation period were included. Sensation threshold (ST), functional threshold (FT), the titrated stimulation intensity (SI) and the apnea-hypopnea index (AHI) were recorded. RESULTS A total of 82 patients were enrolled (gender 69 m, 13 f, age 60 ± 11 years, BMI 29. 8 ± 4.0 kg/m²). Two months after surgery (M2) the median ST was 0.8 ± 0.5V. During thSTUDY OBJECTIVES Drug-induced sleep endoscopy (DISE) has been suggested to be a valuable method for determining the obstruction patterns causing sleep-disordered breathing. However, since DISE is not performed throughout the duration of sleep but for less than an hour, the reproducibility and reliability of DISE are questionable. Therefore, we aimed to determine the test-retest reliability of DISE using midazolam. METHODS Thirty-four patients diagnosed with obstructive sleep apnea were prospectively included in this study. The patients underwent two separate DISE examinations that were performed at different days using the same drug and technique. For a more accurate comparison, the depth of sleep and examination time were identically controlled. VOTE classification was used to classify the obstruction findings, and the findings of upper airway obstruction were compared between the two tests. RESULTS There were 30 men and four women; the mean age was 45.4 ± 13.1 years. The mean apnea-hypopnea index was 38.3 ±STUDY OBJECTIVES The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (i.e. oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared to control therapy or no treatment in improving Apnea-Hypopnea Index [AHI] (primary outcome), sleepiness and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). METHODS Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane and Web of Science up to November 2018 were included and assessment of risk of bias was completed using the Cochrane handbook. RESULTS Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight out of the nine studies measured AHI and showed a weighted average overall AHI improvement of 39.5% vs baselines after respiratory muscle therapy. Based on our meta-analyses in adult stReproductive traits have a major influence on the economic effectiveness of horse breeding. However, there is little information available. We evaluated the use of reproductive traits as selection criteria in official breeding programs to increase the reproductive efficiency of breeding studs, analysing 696 690 records from the pedigree data of eight Spanish horse populations, with different breeding purposes. The reproductive parameters studied in both sexes were age at first foaling (AFF), age at last foaling, average reproductive life and generational interval. In the females, the average interval between foaling (AIF) and interval between first and second foaling were also studied. There were clear differences between sexes and breeds, which may be due to management practices, breeding purposes and the status of the populations, rather than to differences in actual physiological conditions. Riding mares were the most precocious (AFF, 1937.64 to 2255.69 days) and had a more intensive reproductive use (AIF,BACKGROUND UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential. AIMS Describe the development, implementation and results of this questionnaire. METHOD An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use. RESULTS A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45-82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socOBJECTIVES Collaboration and cooperation are critical for public health management. Nevertheless, collaboration and cooperation between government departments, as well as other entities, are still in a weak condition in China. This article analyzes the status of collaboration and cooperation in the management of public health services in China and explores the problems and gives strategic suggestions for strengthening collaboration and cooperation in the development of public health service systems in China, in order to provide a reference for improvement of public health management in the future. METHODS This study uses a qualitative case study approach, including documents review, in-depth interview, and focus group. RESULTS The main problems of collaboration and cooperation in public health service management in China include problems of effective collaboration and cooperation between institutions and relevant departments, public information platform, and implementation of public health and health promotion.