Yes / Fidelity to the treatment protocol is key to successful trials but often problematic. This article reports the staff's views on delivering a complex rehabilitation intervention: patient-led therapy during inpatient stroke care. An exploratory qualitative study using focus groups with staff involved in a multicenter (n = 12) feasibility trial of patient-led therapy (the MAESTRO trial) was undertaken as part of the evaluation process. Purposive sampling ensured that participants represented all recruiting sites, relevant professions and levels of seniority. Data analysis used a Framework Approach. Five focus groups were held involving 30 participants. Five main themes emerged: the effect of the interventions, practical problems, patient-related factors, professional dilemmas, and skills. Staff felt the main effect of the therapies was on patients' autonomy and occupation; the main practical problems were the patients' difficulties in achieving the correct position and a lack of space. Staff clearly identified characteristics that made patient-led therapy unsuitable for some patients. Most staff experienced dilemmas over how to prioritize the trial interventions compared to their usual therapy and other clinical demands. Staff also lacked confidence about how to deliver the interventions, particularly when adapting the interventions to individual needs. For each barrier to implementation, possible solutions were identified. Of these, involving other people and establishing a routine were the most common. Delivering rehabilitation interventions within a trial is complex. Staff require time and support to develop the skills, strategies and confidence to identify suitable patients, deliver new treatments, adapt the new treatments to individuals' needs and balance the demands of delivering the trial intervention according to the treatment protocol with other clinical and professional priorities. TRIAL REGISTRATION: ISRCTN: ISRCTN29533052 . October 2011.

No / This study explores GP tutor views of a nationally derived list of quality criteria for undergraduate and postgraduate practice-based teaching. Whilst these published criteria provided a means of benchmarking locally, an evaluation of utility in practice required further exploration. This educational evaluation was conducted within a West Yorkshire locality as a means of supporting their practice-based primary care education. A survey approach using an online Likert scaled questionnaire was distributed to all GP tutors with an additional opportunity for free text qualitative comments. Data were analysed using an online reporting package for survey results (MarketSight) and thematic analysis of qualitative data. Key findings were that in general all the criteria were rated having a high level of importance with 83% of GPs claiming they would find such a list important in directing their learning and teaching approach. The opinions on out-of-hours experiences for medical students were also interesting as they differed greatly. These findings will be of interest to those involved in the organisation and delivery of medical education within primary care as the list of criteria could act as a structural guide for directing medical student teaching, learning and its quality assurance. Implications for further research include the utility of core criteria and the exploration of out-of-hours experience for medical student education.

Yes / Adults with amblyopia ('lazy eye'), long-standing strabismus (ocular misalignment) or both typically do not experience visual symptoms because the signal from weaker eye is given less weight than the signal from its fellow. Here we examine the contribution of the weaker eye of individuals with strabismus and amblyopia with both eyes open and with the deviating eye in its anomalous motor position. The task consisted of a blue-on-yellow detection task along a horizontal line across the central 50 degrees of the visual field. We compare the results obtained in ten individuals with strabismic amblyopia with ten visual normals. At each field location in each participant, we examined how the sensitivity exhibited under binocular conditions compared with sensitivity from four predictions, (i) a model of binocular summation, (ii) the average of the monocular sensitivities, (iii) dominant-eye sensitivity or (iv) non-dominant-eye sensitivity. The proportion of field locations for which the binocular summation model provided the best description of binocular sensitivity was similar in normals (50.6%) and amblyopes (48.2%). Average monocular sensitivity matched binocular sensitivity in 14.1% of amblyopes' field locations compared to 8.8% of normals'. Dominant-eye sensitivity explained sensitivity at 27.1% of field locations in amblyopes but 21.2% in normals. Non-dominant-eye sensitivity explained sensitivity at 10.6% of field locations in amblyopes but 19.4% in normals. Binocular summation provided the best description of the sensitivity profile in 6/10 amblyopes compared to 7/10 of normals. In three amblyopes, dominant-eye sensitivity most closely reflected binocular sensitivity (compared to two normals) and in the remaining amblyope, binocular sensitivity approximated to an average of the monocular sensitivities. Our results suggest a strong positive contribution in habitual viewing from the non-dominant eye in strabismic amblyopes. This is consistent with evidence from other sources that binocular mechanisms are frequently intact in strabismic and amblyopic individuals.

Soil is one of the largest ecosystems being ignored by human activities. Our farming practices and urban constructions have contributed to its degradation, with far-reaching consequences for the water cycle’s equi- librium.Reconnect with nature and learn the methods to assist in its recovery are essential for the survival of all inhabitants on this planet.  My degree project consists of a large research into the water cycle of urban areas, studying the particular case of Stockholm, that leads to the problems of degraded soil. The aim is to understand the relation- ship between water cycle and soil ecosystems and explore potential solutions.  As a result, I have designed KURITA, a learning tool founded upon the ecofeminism values of care, that serves as a learning method for citi- zens to reconnect with soil values and actively participate in its restor- ative process.

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Behandlingar inom hälso- och sjukvården måste överensstämma med kravet på vetenskap och beprövad erfarenhet (VBE) för att erbjudas patienter enligt svensk rätt. Däremot underställs inte medicinsk forskning som avser människor kravet på VBE eftersom behandlingar som ges till människor inom ramen för forskning inte har beprövats i samma utsträckning som behandlingar inom hälso- och sjukvården och anses såldes inte lika effektiv och säker. Behandlingar inom ramen för forskning får i stället utföras på människor efter ett godkännande av Etikprövningsmyndigheten i enlighet med lag (2003:460) om etikprövning av forskning som avser människor (EPL).  Experimentella behandlingsmetoder har inget uttryckligt lagstöd i svensk rätt men tillämpas i den medicinska praktiken; det handlar om metoder utöver gängse behandlingspraxis som syftar till att ge bot eller lindring till en enskild patient. Sådana behandlingsmetoder uppfyller inte kravet på VBE men anses inte heller omfattas av EPL. Metoderna är således oreglade men motiveras med hjälp av medicinska normer. Att utöva vård inom hälso- och sjukvården som inte lever upp till kravet på VBE är ansvarsgrundande, men enligt nödrätten i 24:4 brottsbalken (BrB) kan utövandet av experimentella behandlingsmetoder innebära ansvarsfrihet vid skuldfrågan. Således finns det utrymme att utföra oreglerade experimentella behandlingar utan att ställas till svars om patienter kommit till skada, eller till och med avlidit.  Det nuvarande rättsliga systemet skiljer med andra ord på människor som utgör patienter och människor som undergår medicinsk forskning och benämns som forskningspersoner. Den kliniska forskningen är däremot inte sällan beroende av vårdens resurser samt strukturer och den grupp som oftast rekryteras till forskningsstudier är just patienter. I praktiken kan alltså en patient också vara en forskningsperson. Hälso- och sjukvårdslagstiftningen skall således vara tillämpbar på en patient som dessutom genomgår forskning och som också enligt EPL utgör en forskningsperson, men varken författningstext eller förarbeten till aktuella regelverk klargör varandras samexistens och således skapas ett juridiskt ingenmansland.  Enligt internationella konventioner om mänskliga rättigheter som Sverige förbundit sig till får ingen utsättas för vetenskapliga och medicinska ingrepp utan ett frivilligt och informerat samtycke. Den svenska rätten är däremot inte förenlig med internationell rätt eftersom det är möjligt att enligt EPL forska på människor utan inhämtandet av ett informerat samtycke.  Patienter och forskningspersoner är en sårbar grupp eftersom sjukdom och nedsatt hälsa inte sällan försvagar oss. Det kan handla om människor som på olika sätt har en nedsatt funktionsförmåga. Patienter och forskningspersoner kan således ha svårt att ta tillvara sina egna intressen och det kan innebära att det kan vara svårt att förstå risker och konsekvenser som är förenade med olika ingrepp. Legala ställföreträdare som kan ta beslut i frågor som rör en annan människas vård och behandling om denne inte själv är kapabel till att ta ett beslut saknas i svensk rätt, vilket också strider mot traktat som Sverige har ingått.  Den svenska hälso- och sjukvårdslagstiftningen är dessutom inte en rättighetsbaserad lagstiftning vilket innebär att enskilda inte kan gå till domstol och få sina rättigheter prövade. Enskildas enda rättsliga möjlighet är i sådana fall att söka anhängiggöra svensk domstol genom åberopandet av Europakonventionen (EKMR) genom 3:4 Skadeståndslagen (SkL), under förutsättningen att rättigheter enligt konventionen har överträtts. Det kan alltså ifrågasättas om människor som genomgår medicinska behandlingar i Sverige innehar adekvata rätts- och skyddsmekanismer och om det rättsliga systemet på ett tillfredsställande sätt skyddar och respekterar människors rätt till ett fritt och informerat samtycke.

The experiments reported within this thesis use psychophysical techniques to examine the factors which determine perceived multisensory timing in humans. Chapters 1 and 2 describe anatomical and psychophysical features of temporal processing, respectively, whilst Chapter 3 introduces the reader to psychophysical methods. Chapter 4 examines the relationship between two measures of sensory latency, reaction time (RT) and crossmodal temporal order judgment (TOJ). Despite task and attentional manipulations the two measures do not correlate, suggesting that they measure some fundamentally different aspect(s) of temporal perception. Chapter 5 examines the effects of adaptation to asynchronous stimulus pairs on perceived audiovisual (AV), audiotactile (AT) and visuotactile (VT) temporal order. Significant temporal shifts are recorded in all three conditions. Evidence is also presented showing that crossmodal TOJs are intransitive. Chapter 6 shows that concurrent adaptation to two sets of asynchronous AV stimulus pairs causes perceived AV temporal order to recalibrate at two locations simultaneously, and that AV asynchrony adaptation effects are significantly affected by observers' attention during adaptation. Finally, Chapter 7 shows that when observers are accustomed to a physical delay between motor actions and sensory events, an event presented at a reduced delay appears to precede the causative motor action. The data are well-described by a simple model based on a strong prior assumption of physical synchrony between motor actions and their sensory consequences.

Widefield surface plasmon resonance (WSPR) microscopy provides high resolution imaging of interfacial interactions. We report the application of the WSPR imaging system in the study of the interaction between keratinocytes and liquid crystals (LC). Imaging of fixed keratinocytes cultured on gold coated surface plasmon substrates functionalized with a thin film of liquid crystals was performed in air using a 1.45NA objective based system. Focal adhesion of the cells adhered to glass and LC were further studied using immunofluorescence staining of the vinculin. The imaging system was also simulated with 2x2 scattering matrix to investigate the optical reflection of the resonant plasmonic wave via the glass/gold/cell and glass/gold/LC/cell layers. WSPR imaging indicated that keratinocytes are less spread and formed distinct topography of cell-liquid crystal couplings when cultured on liquid crystal coated substrates. The simulation indicates that glass/LC shifted the surface plasmon excitation angle to 75.39 degrees as compared to glass/air interface at 44 degrees . The WSPR microcopy reveals that the cells remodelled their topography of adhesion at different interfaces.

Five humans were exposed to a matching to sample task in which the delay (range = 0 to 32 seconds) between sample stimulus offset and comparison onset was manipulated across conditions. Auditory stimuli (1” tone) and arbitrary symbols served as sample stimuli for three (S1, S2, S3) and two (S4 and S5) subjects, respectively. Uppercase English letters (S, M, and N) served as comparison stimuli for all subjects. Results show small but systematic effects of the retention interval on accuracy and latency to selection of comparison stimuli. The results fail to show a difference between subjects exposed to auditory and visual sample stimuli. Some reasons for the failure to note a difference are discussed.

The prevalence of respiratory symptoms indicative of asthma in children from Latin America has been largely ignored. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), 17 centers in 9 different Latin American countries participated in the study, and data from 52,549 written questionnaires (WQ) in children aged 13-14 years and from 36,264 WQ in 6-7 year olds are described here. In children aged 13-14 years, the prevalence of asthma ever ranged from 5.5-28%, and the prevalence of wheezing in the last 12 months from 6.6-27%. In children aged 6-7 years, the prevalence of asthma ever ranged from 4.1-26.9%, and the prevalence of wheezing in the last 12 months ranged from 8.6-32.1%. The lower prevalence in centers with higher levels of atmospheric pollution suggests that chronic inhalation of polluted air in children does not contribute to asthma. Furthermore, the high figures for asthma in a region with a high level of gastrointestinal parasite infestation, and a high burden of acute respiratory infections occurring early in life, suggest that these factors, considered as protective in other regions, do not have the same effect in this region. The present study indicates that the prevalence of asthma and related symptoms in Latin America is as high and variable as described in industrialized or developed regions of the world. / Revisión por pares