Use Of External Support Research Articles

EPIDEMIOLOGY, RISK FACTORS AND CONSERVATIVE TREATMENT OF CHRONIC ANKLE INSTABILITY: A REVIEW OF SYSTEMATIC REVIEWS

Chronic ankle instability is a condition that often occurs after a lateral ankle sprain. It affects daily activities, quality of life and can cause further ankle injuries. The purpose of this article is to systematically review and compare the effectiveness of physiotherapy methods and techniques, epidemiology, and risk factors of chronic ankle instability. A literature search was performed using the PubMed database for existing systematic reviews and meta-analyses. The results show that the prevalence of chronic ankle instability is 46% in people with a history of ankle sprains and is highest in adolescents. In addition, risk factors are poorly understood. Balance training has been shown to be the most effective among standalone treatments. It improves functionality, instability, dynamic balance, and health-related quality of life. Furthermore, a multimodal program is effective in improving self-reported ankle function. Vibration is a useful adjunct to exercise because it improves sensorimotor deficits. Joint mobilization is effective in increasing ankle dorsiflexion and improving balance. Despite the frequent use of external support, it has not been supported as a sole intervention.

Using occupational therapy principles and practice to support independent message generation by individuals using AAC instead of facilitated communication

Facilitated communication (FC) has been a heavily debated and documented topic across multiple disciplines, including sociology, education, psychology, pediatrics, speech-language pathology, and disability studies. Although many professionals from various disciplines and advocates have offered opinions, suggestions, and research on the topic, there has been minimal input from the occupational therapy (OT) profession. The lack of OT input is noteworthy as OTs are experts in enabling upper extremity performance and independence through a variety of training, adaptation and modification strategies, and use of external supports. Because of their professional code of ethics and a specific knowledge base, OTs are uniquely positioned to provide a host of ethical and evidence-based strategies that enable independent access to communication technology. The consideration of multiple access options is contrary to the typical facilitated encounter where facilitators exclusively choose to manipulate an upper extremity in order for letters to be selected on a display or keyboard. The purpose of this paper is threefold: (a) To offer insight into the standard of care by OTs including their ethical standards; (b) to identify varied accommodations that enable access using a feature-matching standard of care that eliminates the need for a facilitator; and (c) to highlight how to increase independent assistive technology/augmentative and alternative communication access, thus dissuading the need or use of facilitated access to letters.

Level of Concern, Spending, and External Support Related to COVID-19: A Comparison between Working and Non-Working Older Adults.

This study compared levels of concern, spending, and use of external support by working status among older adults in the U.S. during the COVID-19 pandemic. It assessed whether work influences these variables related to wellness. Data from 2489 older adults from the 2020 U.S. Health and Retirement Study were analyzed using multiple linear and logistic regression. Older adults who worked had lower concerns about the pandemic (β = −0.28, p = 0.048), were less likely to increase their spending (OR = 0.74, p = 0.041), and were less likely to use external support (OR = 0.50, p < 0.001). Use of external support increased with age (OR = 1.04, p < 0.001) and increased spending (OR = 1.32, p = 0.019). Married older adults were less likely to increase spending (OR = 0.75, p = 0.007) and had lower concerns toward COVID-19 (β = −0.28, p = 0.011). Higher levels of concern were reported among women (β = 0.31, p = 0.005) and participants who had friends or family members diagnosed with COVID-19 (β = 0.51, p < 0.001). Women were more likely to use support (OR = 1.80, p < 0.001). Work appears to bolster older adult wellness outcomes.

Why farmers perceive the use of e-government services as an administrative burden: A conceptual framework on influencing factors

In many countries around the world, family farms are expected to use e-government services to handle data exchange electronically via the internet with the government to fulfill their information obligations. This paper aims to explore the factors influencing the extent to which farmers perceive the use of such services as burdensome, and to develop a framework to categorize these factors for the farming sector. To do this, we extracted a conceptual framework designed for commercial businesses and adapted it to the farming sector. We employed a qualitative case study in Switzerland and conducted face-to-face interviews with six farmers using contrast sampling. The interviews were examined by applying thematic analysis. We found influencing factors from four different fields: (1) farm and farmer characteristics (e.g., farm structure, farmer's attitude toward ICT, farmer's ICT competence, use of external support, work organization, and infrastructure), (2) usage characteristics of e-government services (e.g. quantity and frequency of data entry, and period in use), (3) perceived characteristics of e-government (e.g., network, documentation, software design, complexity, farm compatibility, and duplication), and (4) perceived farm impact (data-security). We further found that the use of e-government services has no organizational benefits for family farms. Our findings provide a conceptual framework for understanding why e-government services for farmers might contribute to either a decrease or increase in their perceived administrative burden. It further provides policy-relevant information about the factors that play a role in digital direct payment administration to reduce farmers' administrative burdens.

Supporting Persons With Severe Dementia in Communicating Their Preferences

Government mandates require US nursing homes to provide preference-based, person-centered care. Persons with dementia (PWD) are less likely to have a role in preference assessments (PAs) used for care planning due to communication challenges associated with the disease. Thus, PWD are at risk of receiving de-personalized treatments. External supports (photograph and text cues) are known to improve communication in PWD. Yet these cues have never been studied with widely used PAs, such as the MDS 3.0 Section F and Preferences for Everyday Living Inventory (PELI). This study examined the effect of two PA conditions (externally supported; standard verbal) on preference consistency and response types (off-topic, clarification requests, elaboration) of residents with severe dementia (N=21) (BIMS < 7) when assessed twice, one-week apart. PA questions were derived from the MDS 3.0 Section F and PELI. As a social validity measure, naïve judges (N=10) listened to interviews and rated residents’ communication clarity and their confidence understanding residents’ preferences. Results showed that neither condition promoted significantly greater levels of consistency over time. Residents’ ‘clarification requests’ were significantly fewer with use of external supports. Other response types were not significantly different across conditions. Judges’ ratings were not significantly different across conditions; however, they rated residents’ communication as clear and understandable overall. This study addresses a gap in current research and holds important implications for helping providers meet government mandates and enhance care plan participation by residents with severe dementia and other communication challenges.

Pediatric pharmacists' perspectives on essential skills and activities for community pharmacists caring for pediatric patients: A mixed-methods study.

Provision of care to pediatric patients represents a set of unique challenges for pharmacists. Pharmacists practising in pediatric-specialty areas (acute care or ambulatory) have unique perspectives on approaches to pediatric care that can be shared to support pharmacists less familiar with this group of patients in providing effective, patient-centred care. This was a mixed-methods study using data from pharmacist interviews to quantify and qualitatively describe the approaches to care most commonly reported by pediatric-specialty pharmacists when asked to provide advice to pharmacists on providing pharmaceutical care to infants and children. Data were coded in duplicate using an inductive approach, and discrepancies were resolved by consensus. The number of times a theme (or subtheme) was mentioned and the number of pharmacists who mentioned it were used as markers of the relative importance of the content. The themes (and subthemes) that emerged as most important were clinical activities (dose checks, considering indication, using up-to-date height/weight), caregiver counselling (demonstrating measurement, discussing administration), medication safety (using consistent concentrations of liquids), compounded medications (risks of, use of caution), adherence (formulation considerations, palatability), avoiding use of over-the counter products (except analgesics/antipyretics) and use of external supports (colleagues, caregivers, resources). We present a collated and prioritized list of practical approaches for pharmacists to use when caring for pediatric patients across the spectrum of practice. Can Pharm J (Ott) 2020;153:xx-xx.

Жизнеспособность семьи в стрессогенных ситуациях инвалидности в зарубежных исследованиях

A review of foreign studies reflecting the problems of family resilience in the modern world is presented. Special emphasis is placed on studies of family resilience in stressful situations of disability of family members. It is shown that resilience of families having stressful experience of disability includes: 1) a system of family beliefs based on a positive outlook that contribute both to self-recovery after a traumatic experience and acceptance of their vulnerability; 2) patterns of family reactions to diseases allowing them to find life meaning in caring, and respond effectively to challenges of diseases, use adaptive capabilities to counteract violations, and organize themselves; 3) family communication skills and activity in problem solving; 4) family connectedness and flexibility, effective use of external support from social and non-government organizations. The family resilience construct is considered through closely related concepts of individual, family, and social resilience.

Factores de riesgo para síndrome de caídas en adultos mayores con polifarmacia

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; determinar los factores de riesgo asociados al síndrome de caídas en adultos mayores con polifarmacia. &lt;strong&gt;Métodos: &lt;/strong&gt;se llevó a cabo un estudio transversal, de marzo a abril de 2019. Se incluyeron adultos mayores de 60 años que acudieron a consulta externa en la Unidad de Medicina Familiar No. 28, con prescripción y consumo mínimo de cuatro fármacos simultáneamente (polifarmacia). Para evaluar las caídas se utilizó el cuestionario de estudio de la Organización Mundial de la Salud (oms). Se evaluaron como factores de riesgo de caídas las variables: edad, sexo, estado civil, escolaridad, peso, talla, índice de masa corporal, tipo de medicamentos, comorbilidades y uso de apoyos externos al desplazarse. Para conocer las diferencias de acuerdo con la presencia de caídas se utilizó la prueba de &lt;span&gt;χ&lt;/span&gt;&lt;sup&gt;2 &lt;/sup&gt;en las variables cualitativas, para determinar los factores de riesgo para caídas se calcularon or y se realizó un modelo de regresión logística ajustado por el uso de antidepresivos, diuréticos y benzodiacepinas. &lt;strong&gt;Resultados:&lt;/strong&gt; se incluyó a un total de 264 pacientes, la mediana de medicamentos consumidos fue de seis (ric 4-7), los fármacos que se prescribieron con mayor frecuencia fueron los antihipertensivos, antiinflamatorios no esteroides y diuréticos. Del total de los participantes, 79 presentaron caídas en los últimos seis meses (29.9%). Al analizar los factores de riesgo asociados a caídas en el modelo multivariado, el uso de antidepresivos mostró un or 3.14 (ic 95% 1.46-6-71) y el de diuréticos un or 1.84 (ic 95% 1.1-3.37). &lt;strong&gt;Conclusión:&lt;/strong&gt; los factores de riesgo asociados a caídas en pacientes con polifarmacia fueron el consumo de antidepresivos y diuréticos.&lt;/p&gt;

The use of external support and the benefits of the adoption of resource efficiency practices: An empirical analysis of european SMEs

The purpose of this paper is to examine the relationship between the use of external support for the adoption of resource efficiency practices and the extent and profitability of this adoption by Small and Medium-sized Enterprises (SMEs). We distinguish between direct financial support and indirect support in the form of advice and consulting services related to the adoption of resource efficiency practices. We use data from the 2013 FLASH EUROBAROMETER survey of a sample of European manufacturing SMEs. Our results show that the effects of the adoption of resource efficiency practices on production costs are higher among firms that receive external financial support for adoption, as well as among those firms that adopt a wide set of process reengineering measures for resource efficiency. However, external technical and business advice plays an important role in the extent of adoption of different resource efficiency measures.

Exploring assistive technology use to support cognition in college students with histories of mild traumatic brain injury

Purpose: College students with mild traumatic brain injury (mTBI) may experience chronic cognitive deficits necessitating use of external supports for daily task completion. The purpose of this study was to explore cognitive support system selection and use by students with histories of mTBI when completing novel prospective memory tasks.Materials and methods: We implemented a multiple case study, sequential explanatory mixed-methods design with three participants. Participants completed four experimental phases: (1) background history collection, cognitive assessment completion, pre-trial interview, and selection of two external supports for trial phase use; (2) trial Phase 1 (i.e., 10-days); (3) trial Phase 2 (i.e., 10 days); and (4) post-trial exit interview. We examined participants’ support type and characteristic preferences and evaluated task execution accuracy when implementing differing supports.Results: Participants expressed both collective and unique cognitive aid preferences before trial completion. Trial phase results revealed that task completion accuracy did not alter substantially between trials; however, personal preferences and perceived usefulness of trialled cognitive aid systems appeared to impact support implementation and effectiveness. Themes emerged from post-trial interview relating to the (a) necessity for differing functions of individual systems and (b) importance of trialling devices prior to selection.Conclusions: Results emphasize the necessity of person-centred approaches to treatment due to the variability of performance accuracy and system preferences. The cognitive aid selection and implementation intervention protocol piloted in this study appears beneficial for understanding unique strengths and challenges for college students following mTBI and may be useful for clinicians working with individuals with mTBI.Implications for rehabilitationCollege-aged students with mild traumatic brain injury report unique preferences for no- and high-tech cognitive aids; however, similar patterns emerge relating to preferred system characteristics.Facilitating several trial periods prior to selection and implementation of external cognitive supports for individuals with mild traumatic brain injury is essential given the preference changes that occur post-trial.Implementing a three-phase external cognitive aid selection process appears beneficial for young adults with mild brain injuries.

High-Resolution InSAR Building Layovers Detection and Exploitation

Layover affects the quality of urban interferometric synthetic aperture radar (InSAR) digital elevation models. Moreover, it is generally difficult to interpret because of the superposition of several contributions in a single SAR pixel. In this paper, a novel technique for the extraction of building layovers is first presented. It makes use of the geocoding stage embedded in the InSAR processor. It is shown that building layovers create a regular pattern in the mapping counter, a map describing the number of occurrences of a SAR pixel in the elevation model. Its exploitation yields a generation of a layover map without the use of external supports. The integration in the processor with a limited additional computational load and the capability to isolate layover signatures are additional benefits. Layover patches are then individually analyzed toward a better understanding of the complex urban signal return. A spectral estimation framework is employed to assess the slopes superimposed in the patches. Fringe-frequency estimation is involved. A set of simulations made for a nonparametric (fast Fourier transform) and a parametric (multiple signal classification) technique is performed prior to testing on real data. It is demonstrated that in X-band, for a single interferogram, just one layover contributor, when it dominates over the others, can be extracted with a sufficient accuracy. The algorithms are tested on a TanDEM-X spotlight acquisition over Berlin (Germany).

The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis.

Secondary analysis of a randomized controlled trial. The use of external supports has been questioned because they may lead to weakness in the surrounding muscles. To our knowledge, there is no investigation into the effect of knee supports or braces on quadriceps muscle strength and quadriceps inhibition in individuals with patellofemoral joint (PFJ) osteoarthritis (OA). To investigate the effects of a flexible knee support on quadriceps maximum voluntary contraction (MVC) and arthrogenous muscle inhibition (AMI) in patients with PFJ OA. The study included 108 participants who had at least 3 months of patellofemoral pain and a Kellgren-Lawrence score of 2 or 3 for PFJ OA. The participants were randomized to a group that wore a flexible knee support (brace) or a group that did not wear a support (no brace) in a 6-week randomized controlled trial, followed by an open-label trial, in which all participants wore the brace for a total of 12 weeks. Quadriceps MVC, measured isometrically, and quadriceps AMI, measured by twitch interpolation, were assessed at the 6-week and 12-week time points. After 6 weeks, MVC did not differ between the brace and no-brace groups (9.09 Nm; 95% confidence interval [CI]: -4.89, 23.07; P = .20). Arthrogenous muscle inhibition significantly decreased in the brace group (-8.62%; 95% CI: -13.90%, -3.33%; P = .002). After 12 weeks, in all of the participants who wore a flexible knee support, MVC increased by 7.98 Nm (95% CI: 2.52, 13.45; P = .004) and AMI decreased (-8.42%; 95% CI: -11.48%, -5.36%; P<.001). Although statistically significant, these results have doubtful clinical significance. A patellofemoral flexible knee support in participants with PFJ OA does not have an adverse effect on quadriceps MVC or AMI. Using a knee support should not be discouraged because of concerns about deleterious effects on quadriceps strength and inhibition. Therapy, level 1b.

Systematic Review of the Effectiveness of Occupational Therapy–Related Interventions for People With Parkinson’s Disease

We describe the results of a systematic review of the literature on occupational therapy-related interventions for people with Parkinson's disease (PD). Three broad categories of intervention emerged: (1) exercise or physical activity; (2) environmental cues, stimuli, and objects; and (3) self-management and cognitive-behavioral strategies. Moderate to strong evidence exists for task-specific benefits of targeted physical activity training on motor performance, postural stability, and balance. Low to moderate evidence indicates that more complex, multimodal activity training supports improvement in functional movement activities. The evidence is moderate that the use of external supports during functional mobility or other movement activities has positive effects on motor control. In addition, moderate evidence is available that individualized interventions focused on promoting participant wellness initiatives and personal control by means of cognitive-behavioral strategies can improve targeted areas of quality of life. The implications for practice, education, and research are discussed.

Helping hands: external support for the KNU insurgency in Burma

This article analyses to what extent the Burmese KNU insurgency made use of external support from states, refugees, and diasporas. Based on extensive fieldwork it is concluded that support from neighbouring states and refugees has for years kept the Karen rebellion alive. Western countries perceived forms of resistance to the illegitimate Burmese regime as just and have therefore played a crucial role in the continuation of conflict in Karen State. It is important that policymakers and donors as well as executing organizations continue to reflect critically on the way they exercise their work.

External Support of a Polytetrafluoroethylene Graft Improves Patency for Bypass to Below-Knee Arteries

Patency and limb salvage after synthetic bypass to the arteries below the knee are inferior to that which can be achieved with autologous vein. The use of external support of synthetic polytetrafluoroethylene (PTFE) grafts to the below-knee position has been suggested to improve patency and limb salvage, a problem analyzed in this randomized clinical trial. We examined whether external graft support improves patency and/or limb salvage in patients undergoing reconstruction with synthetic PTFE grafts to the below-knee arteries. Three hundred thirty-four patients with critical limb ischemia undergoing PTFE bypass to below-knee arteries were randomly assigned to have an ordinary PTFE graft or one with external support. Follow-up was scheduled until amputation, death, or at most 5 years, whichever event occurred first. Patients in both the femoropopliteal and femorodistal groups were randomized to have an externally supported PTFE graft (101/195 patients in the femoropopliteal group and 72/139 patients in the femorodistal group). Follow-up information was available for 329 of 334 randomized patients (99%). At 1 year postprocedure, primary patency for below-knee bypass was 0.55 (95% confidence interval [CI], 0.47-0.64) with and 0.42 (95% CI, 0.34-0.50) without externally supported PTFE grafts, and secondary patency was 0.58 (95% CI, 0.51-0.67) and 0.47 (95% CI, 0.39-0.56), respectively. The corresponding figures for limb salvage were 0.75 (95% CI, 0.68-0.82) and 0.69 (95% CI, 0.62-0.77), respectively. The log rank test revealed statistically significant differences between patients with or without externally supported grafts for patency (primary patency: χ2=4.2 [degrees of freedom=1; P=0.041]; secondary patency: χ2=4.3 [degrees of freedom=1; P=0.037]) but not for limb salvage (limb salvage: χ2=0.2 [degrees of freedom=1; P=0.657]). External support to a PTFE graft used for bypass to below-knee arteries improves primary and secondary patency but not limb salvage.

The Man behind the Curtain: What Cognitive Science Reveals about Drawing

tasks, such as decision making, problem solving, and analogic thinking, might be disrupted by verbalization. In one study people were asked to read groups of stories. Some were asked to verbally discuss each story as soon as they finished it. Others read all the stories without verbally discussing them. Those who waited were better able to uncover the deeper structural similarities and relationships between the stories. Those who verbalized as they read seemed to have been distracted by incidental detail at the expense of global and analogic reasoning. Over time, through both training and experience, the effects of verbal overshadowing do tend to fade; however, meta-analysis has demonstrated the overall reliability of results showing verbal overshadowing.31 One possibility may be that a novice in a particular domain will use words to focus on specific elements, or parts of the whole, rather than the relationships between the parts.32 Domain-specific vocabulary may help to overcome these kinds of biases as deeper levels of conceptual understanding are gained through experience. While it’s easy to say someone has a large nose, it’s more difficult to describe in words the position of the nose in relation to other facial features. This might make sense of the surprising result that verbalization can sometimes impair analogic thinking. Situations are analogous when the relations between the elements, rather than the elements themselves, are similar. Configural, rather than featural, awareness is the kind of thinking needed for analogic reasoning and successful transfer of knowledge from one domain to another. Cognitive Error and Metacognition The good news about verbal overshadowing is that it can be overcome through reflective practice.33 We can learn to think smarter. Developing metacognitive skills—the ability to detect and analyze our own thinking processes—can help us overcome many common cognitive errors.34 Intelligence can also be cultivated through “distributed cognition,” in other words, through the use of external supports, which can be social, symbolic, or physical.35

地域づくりを促す地域内の条件と外部支援の効果的活用のあり方

地域づくりを促す地域内の条件と外部支援の効果的活用のあり方

Examining Age and Experience Differences in Use of Knowledge in the World in Everyday Technology Interactions

Competence in technology use during everyday activities is required for continued independence of older adults, and rapid technological changes have made effective design of learning support beyond formal training crucial to maintain this competence. Older adults have reported a preference for specific training and text manuals when they learn to use technologies, but no research has systematically examined what is actually used in everyday life. This study examined age and experience differences in the use of external support (knowledge in the world) over a ten day period. Interviews with participants about technology encounters during this period were analyzed. Three categories of knowledge in the world were identified: social support, instruction, and on-device information. Age differences were found in use of social support and instruction. Age and experience differences were found in use of on-device information. These results confirm the importance of good instructional support for older adults that accommodates age-related declines and differences in specific knowledge. Data also suggest that development of a simple and reliable method for older adults to obtain social support may help low technology older adults to more effectively use everyday technologies and to resolve problems.

The Use of External Consultants by NHS Commissioners in England: What Lessons Can Be Drawn for GP Commissioning?

To describe the current use of external support by commissioners in the English NHS; assess what impact it is having; explore the factors influencing effectiveness; and draw out the implications for the future of NHS commissioning. (1) Two national surveys of primary care trust managers. (2) Qualitative interviews and focus groups with representatives of 12 firms providing support services to commissioners. (3) Focus groups in three primary care trusts and interviews with representatives of two strategic health authorities (SHAs). The majority of survey respondents reported using external support (89% in 2010). Satisfaction levels were reasonably high, with most rating the service received as excellent or good. Perceived impact in the case study sites was mixed, but benefits were reported in a number of areas. There were cases where external support had not achieved its goals. Several factors contributed to success or failure, including difficulties around procuring external support; building effective working relationships; and implementing the ideas generated by external partners. There was evidence that commissioners do not always use support in a way that takes full advantage of the skills existing in external organizations. There was also some evidence that poorer performing organizations may be less successful in using external support effectively. External support can play a role in improving the quality of commissioning. However, certain pitfalls must be avoided if it is to be used effectively. The role of external support will evolve (and may expand) as commissioning responsibilities are transferred to general practice consortia.

Ankle sprain injuries and poor outcome after litigation

A case control study of 30 matched litigants and non-litigants with ankle sprains was performed to assess the effect of litigation on the medium-term outcome (mean: 11.5 months post injury). Incomplete recovery was reported by 76.6% of all litigants compared to 26.7% of non-litigants. The mean period of sleep disturbance, swelling, limping and non-weight bearing, use of external support and crutches was 2.3 days, 2.5, 2.4 weeks and 2.3, 2.4 and 0.6 weeks for the non-litigants. This compares to 7.2 days, 12.8, 10.9 weeks and 9.6, 8.5 and 1.1 weeks for the litigants ( P<0.001 apart from crutch use, P=0.477). The litigating group had a mean period of swelling, limping and non-weight bearing which was up to 4 standard deviations higher than of the respective non-litigants. Giving way was present in 70% of litigants and 60% of non-litigants (NS); 23.3% of litigants and 43.3% of non-litigants perceived physiotherapy to be beneficial.