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BackgroundPeople with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention.MethodsThe recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved.ResultsWe recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document.ConclusionsOccupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.

IntroductionFunctional Neurological Disorder (FND) is common and can lead to multiple emergency department (ED) presentations and unnecessary investigation. Early identification and intervention have been shown to reduce health care costs and re-presentation to acute services by more than 50%1.We created a pilot model to provide early access to a multi-disciplinary FND team for patients assessed by the ED-embedded neurology team (Stroke or Neurology SDEC pathway) to have a new diagnosis of FND. The MDT provided patients with individualised information about FND, pathway navigation, and shown self-management tools.MethodsWe reviewed data for all patients seen to date by the pilot service.ResultsSince commencement in November 2021, nine patients have been seen by the MDT. All patients were seen within two weeks by a neurophysiotherapist and neuropsychiatrist with neurology support.6 were female and median age was 41 years. All presented with limb weakness and/or sensory distur- bance. 7 reported prior anxiety or depression. 6 had psychiatric factors, including Emotionally Unstable Personality Disorder and health anxiety. Follow up, 2 of the 9 patients so far demonstrated reduced health anxiety and increased confidence.ConclusionAn acute FND pathway can provide timely intervention and reduce symptoms for new presentations with FND.1. Stepped care for functional neurological disorder, A new approach to improving outcomes for a common neurological problem in Scotland. Report and Recommendations, NHS Improvement, February 2012

People with severe intellectual disabilities usually have few formal language skills, may not be able to produce or understand speech because of their developmental level and, as they communicate in idiosyncratic ways, carers may have difficulty recognising and interpreting communication. There is currently little known about what interactions involving people with severe intellectual disabilities actually look like. Because of the lack of previous research, an exploratory approach was used to examine this over-arching research aim. Approximately 40 hours of video data of everyday interactions between care staff and people with severe intellectual disabilities were collected from one residential centre and one day centre in the South of England. The main analytic approach used is conversation analysis although ethnographic notes were also made and are drawn upon throughout. At times, other methods are also used. Themes emerged from the data and are 1. Vulnerability 2. Relationships 3. Resistance and 4. Meal-time interactions. It is suggested that: 1. People with severe intellectual disabilities are vulnerable but are often viewed as only vulnerable. A holistic view should be taken when considering risks in the lives of people with severe intellectual disabilities. 2. Close interpersonal relationships can exist between care staff members and people with severe intellectual disabilities and these are demonstrated through their actions. Such relationships should be acknowledged. 3. People with severe intellectual disabilities may resist activities in a number of ways. Ideally staff should acknowledge and respect signs of resistance. Making people as mobile as possible may help to promote independence. 4. Meal-time interactions require co-operation between people with severe intellectual disabilities and care staff. People with severe intellectual disabilities can be active players within these interactions and this should be encouraged. It is also suggested that people with severe intellectual disabilities may be capable of making some decisions which affect their wellbeing. This is in contrast to a current specifier in the DSM-5 (APA, 2013). Practical suggestions for care staff are also provided.

Purpose: To describe the total artificial heart (TAH) device as a bridge to heart transplantation (BTT), and related physical therapy management, while comparisons to left ventricular assist devices (LVAD) are made. Summary: The SynCardia CardioWest Temporary TAH System is the only TAH approved by the Food and Drug Administration (FDA), Health Canada and Consultants Europe (CE) for BTT. CardioWest implantation involves cardiectomy thus avoiding pulmonary hypertension, right heart failure, inotropic or anti-arrhythmic agents, myocardial and valve related problems. CardioWest has a fixed beat rate and cardiac output is dependent upon venous return and preload. Both TAH and LVADs are adaptive with exercise, increasing cardiac output during activities, allowing for conditioning to occur peripherally. Left ventricular assist devices have portable drivers permitting discharge home, while the CardioWest's large driver console necessitates inpatient therapy. Exercise progression, positioning, and monitoring of exercise intolerance are similar with LVAD and TAH. Ventricular fill volumes in TAH dictate cardiac output and require close attention. Cardiectomy in TAH prevents electrocardiography, telemetry, and native pulse rate monitoring. Conclusion: While mechanical differences exist between TAH and LVAD, physical therapists can provide evidence-based treatment for patients with TAH using previously established guidelines for patients with heart failure and mechanical circulatory support.

To describe the total artificial heart (TAH) device as a bridge to heart transplantation (BTT), and related physical therapy management, while comparisons to left ventricular assist devices (LVAD) are made. The SynCardia CardioWest Temporary TAH System is the only TAH approved by the Food and Drug Administration (FDA), Health Canada and Consultants Europe (CE) for BTT. CardioWest implantation involves cardiectomy thus avoiding pulmonary hypertension, right heart failure, inotropic or anti-arrhythmic agents, myocardial and valve related problems. CardioWest has a fixed beat rate and cardiac output is dependent upon venous return and preload. Both TAH and LVADs are adaptive with exercise, increasing cardiac output during activities, allowing for conditioning to occur peripherally. Left ventricular assist devices have portable drivers permitting discharge home, while the CardioWest's large driver console necessitates inpatient therapy. Exercise progression, positioning, and monitoring of exercise intolerance are similar with LVAD and TAH. Ventricular fill volumes in TAH dictate cardiac output and require close attention. Cardiectomy in TAH prevents electrocardiography, telemetry, and native pulse rate monitoring. While mechanical differences exist between TAH and LVAD, physical therapists can provide evidence-based treatment for patients with TAH using previously established guidelines for patients with heart failure and mechanical circulatory support.

The 1836 Prisoners' Counsel Act afforded all prisoners the right to full legal representation. Thereafter, the focus of felony trial proceedings shifted from the accused's character to the forensic scrutiny of evidence by advocates for both sides. This thesis examines the ways in which novels which focused on the presentation and revelation of character remained committed to a character-focused model of representation and how, conversely, writers of sensation and detective fiction began to appropriate the adversarial-evidentiary representational practices which flourished in criminal courts post- l836, and endorsed them as an alternative and more effective means of representing reality.

This article offers practical advice on applying for ethical approval for research involving participants who may be unable to give informed consent. It briefly outlines my own experiences and offers tips on using the Integrated Research Application System website, going to a social care research ethics committee meeting and resubmitting an application.

Mismatch repair proteins suppress recombination between sequences that are similar but non-identical (homeologous). In the yeast Saccharomyces cerevisiae, the nucleotide excision repair proteins Rad1p and Rad10p interact with mismatch repair proteins Msh2p and Msh3p at certain stages of recombination, including processing of terminal non-homology when necessary. Two recombination assays were used to examine the roles of DNA repair proteins in suppression of homeologous recombination and to study the interactions between mismatch repair and nucleotide excision repair proteins. A previously developed inverted repeat assay was modified and used to confirm that the specificities of mismatch recognition of the MutS homologs in recombination are similar to their specificities in DNA repair, with the surprising exception that Msh3p appears to recognize base-base mismatches during recombination. Roles of MutS homologs in recombination suppression independent of MutL homologs were indicated, and the Rad1p/Rad10p heterodimer was found to act in suppression of homeologous recombination. A novel ectopic recombination assay was developed that can place recombination substrates in competition, allowing measurement of the strength of preference for homologous over homeologous substrates. This assay was also used to examine the effect of terminal non-homology on recombination rates. We found that the presence of even small amounts of terminal non-homology inhibits recombination despite the presence of all proteins necessary for its processing, and that disruption of MSH2, MSH3, or RAD1 further reduces the ability of cells to recombine when terminal non-homology must be processed. All recognition of base-base mismatches in this assay proceeded via a Msh2p/Msh6p heterodimer, and 4nt loops did not inhibit recombination.