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    ABSTRACT: Background Alleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived. Objective To address the question: what is the evidence of the experience of having a fall across the life course? Method A qualitative evidence synthesis with key electronic databases searched from 1990-2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of ‘incidents’ related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations. Results The initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors’ systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults’ perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit ‘Fear’. Consequences are related to notions of ‘Control’ and ‘Social standing’. Recovery work involves ‘Adaptation’, ‘Implications’ ‘Social standing’ and ‘Control’. ‘Explanation’ is sought. Conclusions How and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.
    Disability and Health Journal 07/2014; 7(3). DOI:10.1016/j.dhjo.2014.02.001

  • Journal of Interprofessional Care 03/2014; 28(2):173. DOI:10.3109/13561820.2013.856200
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    ABSTRACT: Action learning sets (ALS) are used widely for organisational and workforce development, including in nursing (Anderson and Thorpe, 2004; Pounder, 2009; Young et al., 2010). In the United Kingdom, a multi-faceted educational Pilot programme for new nurses and midwives was implemented to accelerate their clinical practice and leadership development (NHS Education Scotland, 2010). Action Learning Sets were provided for peer support and personal development. The Realistic Evaluation study reported in this paper explored issues of context, mechanism and outcome (Pawson and Tilley, 1997) influencing the action learning experiences of: programme participants (recently qualified nurses and midwives, from different practice settings); and programme supporters. A range of data were collected via: online questionnaires from 66 participants and 29 supporters; three focus groups, each comprising between eight and 10 programme participants; and one focus group with three action learning facilitators. The qualitative data pertaining to the ALS are presented in this paper. Thematic data analysis of context, mechanism and outcome configurations, generated five themes: creating and sustaining a collective learning environment; challenging constructively; collective support; the role of feedback; and effectiveness of ALS. Study outcomes suggest nursing and midwifery action learning should (a) be facilitated positively to improve participants' experience; (b) be renamed to avoid learning methodology confusion; and (c) be outcome focused to evidence impact on practice.
    Nurse education in practice 01/2014; 14(4). DOI:10.1016/j.nepr.2014.01.007
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    ABSTRACT: Water-soluble vitamins are an important class of compounds that require quantification from food sources to monitor nutritional value. In this study we have analysed six water-soluble B vitamins ([thiamine (B1), riboflavin (B2), nicotinic acid (B3, NAc), nicotinamide (B3, NAm), pyridoxal (B6), folic acid (B9)], and ascorbic acid (vit C) with hydrophilic interaction liquid chromatography (HILIC), and compared UV, fluorescent (FLD) and coulometric detection to optimise a method to quantitate the vitamins from food sources. Employing UV/diode array (DAD) and fluorimetric detection, six B vitamins were detected in a single run using gradient elution from 100% to 60% solvent B [10 mM ammonium acetate, pH 5.0, in acetonitrile and water 95:5 (v:v)] over 18 min. UV detection was performed at 268 nm for B1, 260 nm for both B3 species and 284 nm for B9. FLD was employed for B2 at excitation wavelength of 268 nm, emission of 513 nm, and 284 nm/317 nm for B6. Coulometric detection can be used to detect B6 and B9, and vit C, and was performed isocratically at 75% and 85% of solvent B respectively. B6 was analyzed at a potential of 720 mV, while B9 was analyzed at 600 mV, and vit C at 30 mV. Retention times (0.96 to 11.81 min), intra-day repeatability (CV 1.6 to 3.6), inter-day variability (CV 1.8 to 11.1), and linearity (R 0.9877 to 0.9995) remained good under these conditions with limits of detection varying from 6.6 to 164.6 ng mL−1, limits of quantification between 16.8 to 548.7 ng mL−1. The method was successfully applied for quantification of six B vitamins from a fortified food product and is, to our knowledge, the first to simultaneously determine multiple water-soluble vitamins extracted from a food matrix using HILIC.

  • 12/2013; 92:ix-x. DOI:10.1016/B978-0-12-411636-8.10000-8
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    ABSTRACT: The aim of this study was to investigate the effects of the calcium content of a high-carbohydrate, pre-exercise meal on substrate metabolism and appetite sensations before, during, and after exercise. Nine active males participated in 2 trials in a double-blind, randomised, crossover design. After consuming a high carbohydrate (1.5 g·kg(-1) of body mass) breakfast with a calcium content of either 3 (control trial) or 9 mg·kg(-1) of body mass (high milk-calcium (CAL)), participants ran at 60% peak oxygen uptake for 60 min. Following exercise, a recovery drink was consumed and responses were investigated for a further 90 min. Blood and expired gas were sampled throughout to determine circulating substrate and hormone concentrations and rates of substrate oxidation. Visual analogue scales were also administered to determine subjective appetite sensations. Neither whole-body lipid oxidation nor non-esterified fatty acid availability differed between trials. The area under the curve for the first hour following breakfast consumption was 16% (95% confidence interval: 0%-35%) greater for fullness and 10% (95% confidence interval: 2%-19%) greater for insulin in the CAL trial but these differences were transient and not apparent later in the trial. This study demonstrates that increasing the calcium content of a high carbohydrate meal transiently increases insulinemia and fullness but substrate metabolism is unaffected.
    Applied Physiology Nutrition and Metabolism 12/2013; 38(12):1260-7. DOI:10.1139/apnm-2013-0056
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    ABSTRACT: We examined whether unilateral exercise creates perception bias in the non-exercised limb and ascertained whether rTMS applied to the primary motor cortex (M1) interferes with this perception. All participants completed 4 interventions: 1) 15-min learning period of intermittent isometric contractions at 35% MVC with the trained hand (EX), 2) 15-min learning period of intermittent isometric contractions at 35% MVC with the trained hand whilst receiving rTMS over the contralateral M1 (rTMS+EX); 3) 15-min of rTMS over the 'trained' M1 (rTMS) and 4) 15-min rest (Rest). Pre and post-interventions, the error of force output production, the perception of effort (RPE), motor evoked potentials (MEPs) and compound muscle action potentials (CMAPs) were measured in both hands. EX did not alter the error of force output production in the trained hand (Δ3%; P>0.05); however, the error of force output production was reduced in the untrained hand (Δ12%; P<0.05). rTMS+EX and rTMS alone did not show an attenuation in the error of force output production in either hand. EX increased RPE in the trained hand (9.1±0.5 vs. 11.3±0.7; P<0.01) but not the untrained hand (8.8±0.6 vs. 9.2±0.6; P>0.05). RPE was significantly higher after rTMS+EX in the trained hand (9.2±0.5 vs. 10.7±0.7; P<0.01) but ratings were unchanged in the untrained hand (8.5±0.6 vs. 9.2±0.5; P>0.05). The novel finding was that exercise alone reduced the error in force output production by over a third in the untrained hand. Further, when exercise was combined with rTMS the transfer of force perception was attenuated. These data suggest that the contralateral M1 of the trained hand might, in part, play an essential role for the transfer of force perception to the untrained hand.
    PLoS ONE 11/2013; 8(11):e80202. DOI:10.1371/journal.pone.0080202
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    ABSTRACT: Several studies have highlighted the beneficial effects of milk and dairy product consumption in the alleviation of exercise-induced muscle damage, post-exercise soreness sensations and indeed the satiating effects on subsequent appetite and energy intake in adult populations. The aim of this study was to assess the effects of skimmed milk as a recovery drink following exercise on subsequent appetite and energy intake in female recreational exercisers. Using a randomised cross-over design, nine female recreational exercisers (20±1 y) completed a test followed by two main exercise trials (matched for energy expenditure 1.78±0.14 v. 1.75±0.19 MJ; p=0.600). Main trials were conducted following a standardised breakfast and were carried out during the early follicular phase of the menstrual cycle. Following 30 minutes of moderate-vigorous cycling exercise (65% ) 600 mL of skimmed milk or 600 mL of orange juice (475 mL orange, 125 mL water), which were isoenergetic, was ingested followed 60 minutes later with an ad libitum pasta meal. Absolute energy intake was significantly less after consuming milk than after orange juice (2.39±0.70 v. 3.20±0.84 MJ, respectively; p=0.001). Relative energy intake (in relation to energy expenditure) was significantly lower after milk consumption compared to orange juice (0.61±0.72 v. 1.45±0.90 MJ, respectively; p=0.002). Relative energy intake (in relation to the energy content of the test beverages) was also significantly lower after milk consumption compared to orange juice (3.27±0.70 v. 4.13±0.84 MJ, respectively; p=0.003). There were no differences in AUC (x 3-h) subjective appetite parameters (hunger, fullness and desire to eat) between trials. In conclusion, the consumption of skimmed milk following 30 minutes of moderate-vigorous cycling exercise resulted in a reduction in subsequent energy intake, in female recreational exercisers.
    British Journal of Sports Medicine 11/2013; 47(17):e4. DOI:10.1136/bjsports-2013-093073.49

  • Parkinsonism & Related Disorders 10/2013; 20(2). DOI:10.1016/j.parkreldis.2013.10.021
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    ABSTRACT: Limited previous findings have detailed biomechanical advantages following implantation with mobile bearing (MB) prostheses after total knee replacement (TKR) surgery during walking. The aim of this study was to compare three dimensional spatiotemporal, kinematic, and kinetic parameters during walking to examine whether MBs offer functional advantages over fixed bearing (FB) designs. Sixteen patients undergoing primary unilateral TKR surgery were randomised to receive either a FB (n=8) or MB (n=8) total knee prosthesis. Eight age and gender matched controls underwent the same protocol on one occasion. A 12 camera Vicon system integrated with four force plates was used. Patients were tested pre-surgery and nine months post-surgery. No significant differences between FB and MB groups were found at any time point in the spatiotemporal parameters. The MB group was found to have a significantly reduced frontal plane knee range of motion (ROM) at pre-surgery than the FB group (FB=14.92±4.02°; MB=8.87±4.82°), with the difference not observed post-surgery. No further significant kinematic or kinetic differences were observed between FB and MB groups. Fixed bearing and MB groups both displayed spatiotemporal, kinematic, and kinetic differences when compared to controls. Fixed bearing and MB groups differed from controls in six and five parameters at nine months post-surgery, respectively. No functional advantages were found in knees implanted with MB prostheses during walking, with both groups indicative of similar differences when compared to normal knee biomechanics following prosthesis implantation. Level II.
    The Knee 10/2013; 21(2). DOI:10.1016/j.knee.2013.10.007
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