Solihull Hospital

A 21-year-old woman presented with several atrophic papules on her trunk and limbs, accompanied by surrounding erythema. She had a 3-year history of unusual skin lesions and a maternal half-brother who died from malignant Degos disease. We discuss the familial case of Degos disease and highlight several important points of consideration for both physicians and wider multidisciplinary teams.

ABSTRACTObjectivesThis scoping review will explore and map the extent and type of literature related to physiotherapy capabilities in the health care of adult patients at increased risk of osteoporotic fractures and identify gaps in the literature.BackgroundWith an ageing population, osteoporosis and fractures and their associated costs are increasing. Unfortunately, many people with, or at increased risk of, osteoporotic fractures remain undiagnosed and untreated. The scope of physiotherapy has expanded over recent years with enhanced, advanced and consultant roles. This presents opportunities for physiotherapists to help reduce the osteoporosis care gap. Clarifying capabilities is important to ensure successful implementation of new roles and development of holistically competent practitioners.Eligibility CriteriaLiterature will be included if it relates to capabilities of qualified physiotherapists involved in the health care of adult patients (aged 18 and over) at increased risk of osteoporotic fractures in any clinical setting. All published and non‐published literature to include research studies, editorials, and grey literature will be considered.MethodsA scoping review will be carried out in accordance with JBI guidelines. Peer‐reviewed databases including MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane, PEDro and ProQuest will be searched for literature between 2003 and 2025, alongside a comprehensive search for grey literature (including reports and government publications) from additional sources to ensure a broad representation of available evidence. Source selection will use the PRISMA‐ScR flow chart against agreed eligibility criteria. Data extraction will be mapped out in tabular and/or diagrammatic format with a supporting narrative synthesis.Trial Registrationhttps://doi.org/10.17605/OSF.IO/47UYE

In this study, equal channel angular pressing (ECAP) technique was used as the severe plastic deformation method. The ECAP process was applied to the samples of Al–Si–Mg alloy, which further were joined via the friction welding (FW) technique. ECAP was applied to the samples for up to two passes. Microstructural and mechanical characterization of the material, tensile and hardness tests, as well as the optical microscope (OM), scanning electron microscope (SEM), and fractured-surface examinations were performed after the homogenization process and after each ECAP pass. In the study, the FW joining of Al–Si–Mg alloy samples preliminarily subjected to ECAP process and the effects of microstructure on the mechanical properties of FW joining of ECAP materials were examined. The aim of the study is to examine the mechanical effect of the material, which is pre-processed with severe plastic deformation, on the friction welding. As a result, in mechanical properties, a 30–40% increase in hardness was observed in ECAP 1 and 2 passes compared to homogenized materials, while an increase in yield strength was observed in direct proportion to the increase in the number of ECAP passes. Reduction in grain sizes after the ECAP process positively affected the strength and hardness values.

ABSTRACTThe Zechstein reservoir of the Alma field (originally Argyll, formerly Ardmore) comprises at least four Zechstein carbonate and evaporite sequences, the latter dissolved during Jurassic exposure, forming a series of collapse breccias that were modified by karst, erosion and faulting. It is essential to identify the different origins of these breccia bodies because these processes produce zones of excess permeability with contrasting stratiform and cross‐cutting geometry. In core, these breccia bodies are distinguished by their clast assemblage and fabric, the relationship of clasts and matrix, the presence of sedimentary structures and the nature of their upper and lower boundaries. Predicting the distribution, architecture and reservoir quality of these geobodies is key to managing reservoir development programmes in similar carbonate fields affected by karst, collapse brecciation, reworking and faulting. It requires an understanding of the stratigraphy of the reservoir, particularly that of any internal aquicludes, mapping the palaeogeology of the top reservoir and understanding the onlap history of the exposure surface. The Alma reservoir contains a field‐wide impermeable layer, the Sapropelic Dolomite deposited in a basinal setting that controlled the influx of meteoric water during exposure. The lower dolomite breccia, which underlies the Sapropelic Dolomite, represents a stratiform evaporite collapse breccia formed by dissolution in meteoric water that was introduced down‐dip beneath the Sapropelic Dolomite. The upper dolomite breccia formed by dissolution of one or more evaporite units by direct infiltration of meteoric water from the top Zechstein surface. During the Jurassic, the top Zechstein surface was modified by karst, apart from the SW part of the Alma field, where the Zechstein was buried by the onlapping impermeable Triassic Smith Bank Formation. Core also shows that there is limited karst development over the sub‐crop of the Sapropelic Dolomite. The Zechstein is partly onlapped by Jurassic detrital conglomerates reworked from the brecciated Zechstein and deposited in alluvial fan, shore face and low‐energy subtidal settings along the western margin of the field. A well‐preserved matrix pore system can be expected within collapse breccias and karst cavities where the Zechstein is overlain by Jurassic detrital sandstone and carbonate breccias. However, in areas onlapped by impermeable sediment, the karst and collapse breccias are likely to contain much poorer reservoir quality.

Falls among older adults pose a significant public health challenge, as they lead to severe outcomes such as fractures and loss of independence. Research has shown that training cognitive function and balance simultaneously, termed Dual-Task (DT) training, improves mobility and reduces fall risks in older adults. This study aims to evaluate the feasibility and acceptability of a blended supervised and self-directed technology-based DT training programme for older adults who have high risk of falling. This is a single-arm, non-randomised feasibility study employing quantitative and qualitative methods. Fifty healthy adults aged 65 years or above will be recruited from the NHS primary and secondary care pathways and from the community. Participants will undergo supervised cognitive and balance DT training for 12 weeks, followed by self-directed DT training for an additional 12 weeks. The cognitive training will be delivered using a commercial mobile application (app) available from the AppStore or Google Play. The balance training will involve static (Marching on the spot, Tandem Stand, Hip Abduction & Extension, Squats, Tiptoe Stand, and Pendulum/Sideways Sway) and dynamic (Figure of Eight Walk, Walking Forwards and Backwards, Lunges, Functional Reach, Toe Tapping, Upper Limb Strength Exercises, and Side-Steps/Simple Grapevine) exercises focused on improving balance, postural stability and strength. Feasibility outcomes will be recruitment, adherence, usage of the app, and attrition. Outcomes measure data, that will be collected at baseline and at 24 weeks, includes the Timed- Up and Go (TUG) test (likely primary outcome in any future trial), along with self-reported questionnaires assessing cognition, fear of falling, quality of life, healthcare service usage, and the self-reported number of falls. Focus group interviews will be conducted with thirty participants and thirty healthcare professionals for in-depth exploration of the feasibility and acceptability of the DT training programme.

This service evaluation examined the impact of offloader knee bracing for unicompartmental osteoarthritis (OA) on pain, quality of life (QoL) and activities of daily living (ADL). The retrospective service evaluation was completed at two NHS community primary care clinics offering offloader knee bracing services. Between 2015 and 2023 patients prescribed offloader knee braces with unicompartmental osteoarthritis were invited to complete a Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, one, six and 12months and at two and three years. KOOS data were analysed to assess the change in ADL, Pain and QoL domains from baseline to one, six and twelve months and up to three years using a paired t-test. Demographic data collected included age, sex, and type of OA. Two hundred and forty-three patients were issued an offloader knee brace. There were statistically significant differences in pain and ADL for both braces at one and six months (p<0.05). Participants issued with an ÖSSUR brace demonstrated statistically significant changes in pain and ADL for up to two years (p=0.0101; p=0.0153) and QoL up to one year (p=0.0011). There was no statistically significant difference in either brace at three years. The ÖSSUR brace demonstrated a minimal clinically significant difference at one month for all domains, at one year for pain and ADL and two and three years for pain, ADL and QoL. Results indicate that offloader knee bracing for unicompartmental knee OA could reduce patients' pain, ADL and QoL in the long term.