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Purpose of the ReviewSummarising the evidence for pre- and post-stroke physical activity (PA) and exercise to reduce stroke risk, and improve recovery and brain health.Recent FindingsPre-stroke PA reduces the risk of stroke, and post-stroke PA and exercise reduce cardiovascular risk factors, which can moderate the risk of recurrent strokes. Pre-clinical evidence indicates that exercise enhances neuroplasticity. The results from clinical studies showed that exercise changes brain activity patterns in stroke survivors, which can be a signal neuroplasticity. The intensity of pre- and post-stroke PA and exercise is a key factor with higher intensities leading to greater benefits, including improvement in fitness. Having low fitness levels is an independent predictor for increased risk of stroke.SummaryHigher intensity leads to greater benefits; however, the optimum intensity of PA and exercise is yet unknown and needs to be further investigated. Strategies to decrease sedentary behaviour and improve fitness need to be considered.

Purpose To critically appraise, compare and summarize the measurement properties of self-report fatigue questionnaires validated in patients with multiple sclerosis (MS), Parkinson's disease (PD) or stroke. Methods MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTdiscus were searched. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of studies. A qualitative data synthesis was performed to rate the measurement properties for each questionnaire. Results Thirty-eight studies out of 5,336 records met the inclusion criteria, evaluating 31 questionnaires. Moderate evidence was found for adequate internal consistency and structural validity of the Fatigue Scale for Motor and Cognitive functions (FSMC) and for adequate reliability and structural validity of the Unidimensional Fatigue Impact Scale (U-FIS) in MS. Conclusions We recommend the FSMC and U-FIS in MS. The Functional Assessment of Chronic Illness Therapy Fatigue subscale (FACIT-F) and Fatigue Severity Scale (FSS) show promise in PD, and the Profile of Mood States Fatigue subscale (POMS-F) for stroke. Future studies should focus on measurement error, responsiveness and interpretability. Studies should also put emphasis on providing input for the theoretical construct of fatigue, allowing the development of questionnaires that reflect generic and disease-specific symptoms of fatigue.

Background Sleep disturbance and fatigue are common in individuals undergoing inpatient rehabilitation following stroke. Understanding the relationships between sleep, fatigue, motor performance, and key biomarkers of inflammation and neuroplasticity could provide valuable insight into stroke recovery, possibly leading to personalized rehabilitation strategies. This study aimed to investigate the influence of sleep quality on motor function following stroke utilizing wearable technology to obtain objective sleep measurements. Additionally, we aimed to determine if there were relationships between sleep, fatigue, and motor function. Lastly, the study aimed to determine if salivary biomarkers of stress, inflammation, and neuroplasticity were associated with motor function or fatigue post-stroke. Methods Eighteen individuals who experienced a stroke and were undergoing inpatient rehabilitation participated in a cross-sectional observational study. Following consent, participants completed questionnaires to assess sleep patterns, fatigue, and quality of life. Objective sleep was measured throughout one night using the wearable Philips Actiwatch. Upper limb motor performance was assessed on the following day and saliva was collected for biomarker analysis. Correlation analyses were performed to assess the relationships between variables. Results Participants reported poor sleep quality, frequent awakenings, and difficulties falling asleep following stroke. We identified a significant negative relationship between fatigue severity and both sleep quality ( r =-0.539, p  = 0.021) and participants experience of awakening from sleep ( r =-0.656, p  = 0.003). A significant positive relationship was found between grip strength on the non-hemiplegic limb and salivary gene expression of Brain-derived Neurotrophic Factor ( r  = 0.606, p  = 0.028), as well as a significant negative relationship between grip strength on the hemiplegic side and salivary gene expression of C-reactive Protein ( r =-0.556, p  = 0.048). Conclusion The findings of this study emphasize the importance of considering sleep quality, fatigue, and biomarkers in stroke rehabilitation to optimize recovery and that interventions may need to be tailored to the individual. Future longitudinal studies are required to explore these relationships over time. Integrating wearable technology for sleep and biomarker analysis can enhance monitoring and prediction of outcomes following stroke, ultimately improving rehabilitation strategies and patient outcomes.

If a simple system of instrumented monitoring was possible early after stroke, therapists may be able to more readily gather information about activity and monitor progress over time. Our aim was to establish whether a device containing a dual-axis accelerometer provides similar information to behavioural mapping on physical activity patterns early after stroke. Methods. Twenty participants with recent stroke ≤2 weeks and aged >18 were recruited and monitored at an acute stroke ward. The monitoring device (attached to the unaffected leg) and behavioural mapping (observation) were simultaneously applied from 8 a.m. to 5 p.m. Both methods recorded the time participants spent lying, sitting, and upright. Results. The median percentage and interquartile range (IQR) of time spent lying, sitting, and upright recorded by the device were 36% (15–68), 51% (28–72), and 2% (1–5), respectively. Agreement between the methods was substantial: Intraclass Correlation Coefficient (95% CI): lying 0.74 (0.46–0.89), sitting 0.68 (0.36–0.86), and upright 0.72 (0.43–0.88). Conclusion. Patients are inactive in an acute stroke setting. In acute stroke, estimates of time spent lying, sitting, and upright measured by a device are valid.

Background Improving upper limb (UL) motor recovery after stroke represents a major clinical and scientific goal. We aim to complete three systematic reviews to estimate the (1) association between time to start of UL therapy and motor recovery, (2) relative efficacy of different UL therapy approaches post-stroke and (3) cost-effectiveness of UL therapy interventions. Methods We have designed a systematic review protocol to address three systematic review questions that were each registered with PROSPERO. The search will be conducted in MEDLINE, EMBASE, and Cochrane Controlled Register of Trials. We will include randomised controlled trials, non-randomised clinical trials, before-after studies and observational studies of adult stroke survivors with an average stroke onset < 6 months, undergoing hospital-based therapy to improve UL function. Eligible interventions will aim to promote UL functional recovery. Two reviewers will independently screen, select and extract data. Study risk of bias will be appraised using appropriate tools. Clinical measures of motor recovery will be investigated (primary measure Fugl Meyer UL assessment), as well as measures of health-related quality of life (primary measure EQ-5D) and all cost-effectiveness analyses completed. Secondary outcomes include therapy dose (minutes, weeks, repetitions as available) and safety (i.e. adverse events, serious adverse events). A narrative synthesis will describe quality and content of the evidence. If feasible, we will conduct random effects meta-analyses where appropriate. Discussion We anticipate the findings of this review will increase our understanding of UL therapy and inform the generation of novel, data-driven hypotheses for future UL therapy research post-stroke. Systematic review registration PROSPERO,  http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018019367 , http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018111629 , http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018111628 .

The marine renewable energy (MRE; renewable energy captured from waves, tides, ocean currents, the natural flow of water in rivers, and marine thermal gradients, without building new dams or diversions) industry has a vital role in the U.S. clean energy strategy as we progress to meet U.S. electricity and blue economy needs with renewable, domestic energy sources. However, a thorough assessment of the U.S. marine energy permitting process from the viewpoints of both developers that propose projects and regulators that permit them has not been performed. Sharing practical experiences in this new industry is vital to increase the efficiency and effectiveness of the permitting process, identify data and information gaps, develop lessons learned, and advance the industry. This paper is a case study of qualitative findings, lessons learned, and recommendations from guided discussions, workshops, and webinars with both marine renewable energy developers and state and federal regulators that have experience in the permitting process in the U.S.

Planning is underway for placement of infrastructure needed to begin offshore wind (OSW) energy generation along the West Coast of the United States and elsewhere in the Pacific Ocean. In contrast to the primarily nearshore windfarms currently in the North Atlantic, the seabird communities inhabiting Pacific Wind Energy Areas (WEAs) include significant populations of species that fly by dynamic soaring, a behavior dependent on wind and in which flight height increases steeply with wind speed. Therefore, a more precise and detailed assessment of their 3D airspace use is needed to better understand the potential collision risks that OSW turbines may present to these seabirds. Toward this end, a novel technology called the ThermalTracker-3D (TT3D), which uses thermal imaging and stereo vision, was developed to render high-resolution (on average within ±5 m) flight tracks and related behavior of seabirds. The technology was developed and deployed on a wind-profiling LiDAR buoy in the Humboldt WEA, located 34 to 57 km off California’s coast. During the at-sea deployment between 24 May and 13 August 2021, the TT3D successfully tracked birds moving between 10 and 500 m from the device, around the clock, and in all weather conditions; a total of 1407 detections and their corresponding 3D flight trajectories were recorded. Mean altitudes of detections ranged 6-295 m above sea level (asl). Considering the degree of overlap with anticipated rotor swept zones (RSZ), which extend 25-260 m asl, 79% of detected birds (per m 3 of airspace) moved below the RSZ, 21% moved at heights overlapping the RSZ, and another 0.04% occurred at heights exceeding the RSZ. The high-resolution tracks provided valuable insight into seabird space use, especially at heights that make them vulnerable to collision during various environmental conditions (e.g., darkness, strong winds). Observations made by the TT3D will be useful in filling critical knowledge gaps related to estimating collision and avoidance between seabirds and OSW facilities in the Pacific and elsewhere. Future research will focus on enhancing the TT3D’s identification capabilities to the lowest taxon through validation studies and artificial intelligence, further contributing to seabird conservation efforts associated with OSW.

ObjectivePatient-reported outcomes (PROs) provide self-reported patient assessments of their quality of life, daily functioning, and symptom severity after experiencing an illness and having contact with the health system. Feeding back summarised PROs data, aggregated at the health-service level, to healthcare professionals may inform clinical practice and quality improvement efforts. However, little is known about the best methods for providing these summarised data in a way that is meaningful for this audience. Therefore, the aim of this scoping review was to summarise the emerging approaches to PROs data for ‘service-level’ feedback to healthcare professionals.SettingHealthcare professionals receiving PROs data feedback at the health-service level.Data sourcesDatabases selected for the search were Embase, Ovid Medline, Scopus, Web of Science and targeted web searching. The main search terms included: ‘patient-reported outcome measures’, ‘patient-reported outcomes’, ‘patient-centred care’, ‘value-based care’, ‘quality improvement’ and ‘feedback’. Studies included were those that were published in English between January 2009 and June 2019.Primary and secondary outcome measuresData were extracted on the feedback methods of PROs to patients or healthcare providers. A standardised template was used to extract information from included documents and academic publications. Risk of bias was assessed using Joanna Briggs Institute Levels of Evidence for Effectiveness.ResultsOverall, 3480 articles were identified after de-duplication. Of these, 19 academic publications and 22 documents from the grey literature were included in the final review. Guiding principles for data display methods and graphical formats were identified. Seven major factors that may influence PRO data interpretation and use by healthcare professionals were also identified.ConclusionWhile a single best format or approach to feedback PROs data to healthcare professionals was not identified, numerous guiding principles emerged to inform the field.

Background. The ineffectiveness of most complex stroke recovery trials may be explained by inadequate intervention design. The primary aim of this review was to explore the rationales given for interventions and dose in stroke rehabilitation randomised controlled trials (RCTs). Methods. We searched the Cochrane Stroke Group library for RCTs that met the following criteria: (1) training based intervention; (2) >50% participants who were stroke survivors; (3) full peer-reviewed text; (4) English language. We extracted data on 16 quality items covering intervention dose (n= 3), trial design (n= 10), and risk of bias (n= 3) and 18 items related to trial method. Logistic regression analyses were performed to determine whether (1) reporting of trial quality items changed over time; (2) reporting of quality items was associated with the likelihood of a positive trial, adjusted for sample size and number of outcomes. Results. 27 Cochrane reviews were included, containing 9,044 participants from 194 trials. Publication dates were 1979 to 2013, sample size was median 32 (IQR 20,58), and primary outcome was reported in 49 trials (25%). The median total quality score was 4 (IQR 3,6) and improved significantly each year (OR 1.12, 95% CI 1.07, 1.16, p<0.001). Total quality score was not associated with likelihood of a positive trial, but trials containing a biological rationale for the intervention were more likely to find a difference in patient outcome (OR 2.18, 95% CI 1.14, 4.19, p=0.02). Conclusion. To develop breakthrough treatments we need to build the rationale for research interventions and testing of intervention dosage. This will be achieved through a collective research agenda to understand the mechanistic principles that drive recovery and identification of clearer targets for clinical trials.

Costs to permit Marine Energy projects are poorly understood. In this paper we examine environmental compliance and permitting costs for 19 projects in the U.S., covering the last 2 decades. Guided discussions were conducted with developers over a 3-year period to obtain historical and ongoing project cost data relative to environmental studies (e.g., baseline or pre-project site characterization as well as post-installation effects monitoring), stakeholder outreach, and mitigation, as well as qualitative experience of the permitting process. Data are organized in categories of technology type, permitted capacity, pre- and post-installation, geographic location, and funding types. We also compare our findings with earlier logic models created for the Department of Energy (i.e., Reference Models). Environmental studies most commonly performed were for Fish and Fisheries, Noise, Marine Habitat/Benthic Studies and Marine Mammals. Studies for tidal projects were more expensive than those performed for wave projects and the range of reported project costs tended to be wider than ranges predicted by logic models. For eight projects reporting full project costs, from project start to FERC or USACE permit, the average amount for environmental permitting compliance was 14.6%.