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The processes by which working alliances develop in stroke rehabilitation are not well understood. The aim of this study was to explore the ways in which experienced allied health clinicians establish and maintain alliances with people with stroke-related communication impairment, and to identify factors that may influence the strength of these alliances. In-depth interviews were completed with 11 clinicians from the disciplines of occupational therapy, speech-language pathology and physiotherapy. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory. Participants described processes that were captured by the themes of enabling interaction, being responsive, building relational capital and building credibility. Practices that supported communication and emphasized responding, both within an interaction and over time, aligned with examples of strong alliances. Professional credibility and relational practices such as everyday conversations and the use of humour were viewed as important. Difficulty accessing a shared mode of communication due to stroke-related communication impairment altered relational processes and influenced perceptions of the alliance, although examples of strong alliances were present. In this study, reflections on challenging alliances highlighted potentially helpful practices. A responsive approach to rehabilitation, supported by reflective practice, may assist clinicians to better navigate their working alliances with this population.Objective To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results there was no association between lower limb PT and future falls (p > .05). Conclusion Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.Electronic waste (e-waste) policies have traditionally been based on extended producer responsibility (EPR) principles. In practice, EPR-based e-waste policies primarily involve the creation of regulated collection and recycling channels, with success tied to achieving high collection quotas. However, the majority of EPR programs, particularly those in the Global South, have achieved little success due to competition with the informal sector. Despite this, strikingly little is known of the scope and dynamics of informal e-waste flows and actors during the formulation of e-waste management policies. This study develops and pilots a replicable three-stage model for solid waste researchers, practitioners and policymakers to rapidly assess these informal e-waste systems. This model is demonstrated in Cuenca, Ecuador, and determined the destination of 50-80% of Cuenca's e-waste over a period of three days. The methods used and findings that emerge from this study offer a strategy to rapidly quantify and understand the dynamics of informal e-waste systems to inform EPR-based policies in ways that place informal recyclers at the core of e-waste management. This not only provides creative opportunities for formal systems to achieve e-waste collection quotas through partnerships with the informal sector, but offers a pathway to preserve the livelihoods of marginalized populations reliant on e-waste recycling and decrease environmental harm.Purpose The purpose of this study was to examine the relationship between executive functioning and word learning among preschoolers with and without developmental language disorder (DLD). Method Forty-one preschool-age children with DLD were matched to typically developing children on age and sex. Participants were exposed to 10 novel pseudowords, half of which referred to familiar objects and half of which referred to unfamiliar objects. Their ability to produce, recognize, and comprehend the novel words was tested, and they completed executive function tasks measuring sustained selective attention, short-term memory, working memory, inhibition, and shifting. Results Preschoolers with DLD performed worse compared to typically developing peers on all measures of executive function and novel word learning. Both groups showed a relative weakness in producing pseudowords that corresponded with familiar objects versus pseudowords for unknown objects. https://www.selleckchem.com/products/pkr-in-c16.html Executive function accounted for statistically significant variance in word learning beyond group membership, with inhibition as a significant predictor of all word learning outcomes and short-term memory as a significant predictor of novel word comprehension. Executive function explained significant variance in novel word production and recognition even after accounting for variance explained by group differences in IQ and receptive vocabulary. Conclusion Findings replicate previous research reporting deficits in word learning and executive function in children with DLD, indicate that preschoolers are disadvantaged in learning new words for familiar objects, and support a relationship between executive function and word learning for children with and without DLD. link2 Future research should examine the directionality of the relationship between these variables.It is considered that implementation of the biopsychosocial model (BPSM) within physiotherapy is affected by its lack of conceptual clarity. This concept analysis explores the meaning and offers conceptual transparency to the BPSM and expands upon its current conceptual framework for practice. Method Literature was selected through a systematic search. The studies were analyzed and the data themed following thematic analysis. Results From the seventeen articles included, five master themes and four subthemes were constructed. The master themes were 1) 'Bio-medical factors'; 2) 'Psychological factors'; 3) 'Social factors'; 4) 'Communication'; and 5) 'Individualized Care'. The subthemes were 1) 'Education'; 2) 'Cognitive'; 3) 'Behavioral factors'; 4) 'Occupational factors'; and 5) 'Therapeutic Alliance'. Conclusion A contemporary visual representation of the BPSM is presented which represents a holistic, humanist perspective. 'Communication' scaffolds the framework and supports the exploration of the person's lifeworld through the 'therapeutic alliance'.Objective To compare maternal and neonatal outcomes following cesarean delivery during second stage of labor, according to the fetal extraction method.Methods A retrospective cohort study of all women who underwent term cesarean delivery during the second stage of labor at a university-affiliated tertiary medical center (2012-2016). The cohort was divided according to three extraction methods standard vertex extraction, the push method in which the head extraction is accompanied by pushing through the vagina, and the reverse breech extraction method. Primary outcomes were intraoperative maternal complications, and secondary outcomes were neonatal adverse events.Results Three hundred and fifty women were included, of whom 206 (59%) underwent standard vertex fetal extraction, 116 (33%) the push method extraction, and 28 (8%) reverse breech extraction. Operation time was significantly shorter in the standard vertex extraction method compared to push and reverse breech extraction methods (33.5 vs. link3 40.5 and 39.0 min, respectively, p = .013). Uterine laceration and incision extension frequencies were lower in the vertex extraction method as well (24.76 vs. 45.69-46.40% in others, p less then .001). Delivery related neonatal injury was significantly more frequent in the reverse breech extraction method (39.29 vs. 12-15% in others, p less then .001). In a multivariate analysis reverse breech extraction was associated with higher rates of uterine laceration and incision extension (OR = 2.739 95% confidence interval 1.44-6.56, p = .0237) and delivery related neonatal injury (OR = 2.837, 95% CI 1.081-7.448, p = .0342).Conclusion Standard vertex extraction method during second stage of labor cesarean delivery is safer both to the mother and neonate when compared to alternative extraction methods.Abbreviations NRFHR non-reassuring fetal heart rate; NICU neonatal intensive care unit.Background Environmental interactions are very complex in childhood asthma, and we hypothesized that even a short-term exposure to an allergy safe outdoor environment (AllSOE) combined with pulmonary rehabilitation program (PRP) could exert significant beneficial effects. Our aim was to test the effects of 2-week PRP provided in an AllSOE in children with mild to moderate asthma.Methods 110 children (aged 7.5-17 years, 46% girls), with partially or totally controlled asthma, attended the PRP at the Island of Lošinj (Croatia) supervised by a multidisciplinary team (pediatric pulmonologist, sports medicine specialist, physiotherapist and kinesiologist). Each child had an adjusted intensity of physical activity with at least 2 h of exercise per day. Body height and weight, spirometry, fraction of exhaled nitric oxide (FeNO), running distance during free running test (FRT) and the decline in lung function after FRT (exercise-induced bronchoconstriction- EIB) were measured at baseline and after PRP.Results A significant improvement in running distance (from 903 ± 272 m to 968 ± 289 m; p less then 0.001), a decrease of FeNO (from 37 ± 32 ppb to 25 ± 17 ppb; p less then 0.001) were determined after PRP. There were no significant changes in lung function and EIB, except EIB in the fourth quartile (significant EIB at baseline) where EIB significantly decreased (p less then 0.001) after PRP.Conclusion Two weeks of PRP in an AllSOE significantly improved exercise capacity and reduced airway inflammation and airway hyperreactivity showing that even a short-term PRP within a proper environment could be effective and affordable management strategy for children and adolescents with mild to moderate asthma.Research shows how racism can negatively affect access to health care and treatment. However, limited theoretical research exists on conceptualizing racism in health care. In this article, we use structural violence as a theoretical tool to understand how racism as an institutionalized social structure is enacted in subtle ways and how the "violence" built into forms of social organization is rendered invisible through repetition and routinization. We draw on interviews with health care users from three European countries, namely, Sweden, Germany, and Portugal to demonstrate how two interrelated processes of unequal access to resources and inequalities in power can lead to the silencing of suffering and erosion of dignity, respectively. The strength of this article lies in illuminating the mechanisms of subtle racism that damages individuals and leads to loss of trust in health care. It is imperative to address these issues to ensure a responsive and equal health care for all users.
