SummaryBackgroundResults of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.MethodsFOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.FindingsBetween Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.InterpretationFluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.FundingUK Stroke Association and NIHR Health Technology Assessment Programme.

A stiffer construct can reduce the risk of nonunion and shorten the period of non-weight-bearing.

The transtheoretical model (TTM) was developed as a guide for understanding behavior change. Little attention has been given, however, to the appropriateness of the TTM for explaining the adoption of exercise behavior in older adults. The purposes of this study were to determine the reliability of the TTM instruments and validate TTM predictions in 86 community-dwelling older adults (mean age 75.1 +/- 7.0 years, 87% women) who were participants in a 16-week walking program. TTM construct scales--self-efficacy, decisional balance (pros and cons), and processes of change (behavioral and cognitive)--were generally reliable (all>.78). Behavioral processes of change increased from baseline to follow-up, but pros, cons, and cognitive processes did not change among participants who became regular exercisers. Stage of change did not predict exercise adoption, but baseline self-efficacy predicted walking behavior. These results lend partial support to the TTM in predicting exercise behavior.

Objective -The main objective was to determine whether information literacy (IL) learning objects (LOs) impact student IL competency, specifically in a foundational first year English composition course. The primary research question was: What is the effectiveness of IL LOs compared to face-to-face instruction in terms of students' skill acquisition?Methods -The methods involved testing student IL competency through a multiple-choice test given pre-and post-IL intervention. Effectiveness was measured by assessing whether IL competency improves after exposure to one of two interventions: online IL LOs or face-to-face librarian-led workshop. Over two semesters, equal sections of the course were tested for each of these interventions. For the IL LOs group, students first completed a pre-test, then they worked independently through three online IL LOs. The three IL LOs were videos comprised of animation, screen casting, and video capture on these topics: Finding Articles at Seneca Libraries (hereafter referred to as Finding Articles), Finding Articles on Current Issues, and Popular and Scholarly Sources. The students were then given the same test again. For the face-to-face group, the pre-and post-tests were also required for the same number of sections. This study was conducted under institutional ethics approval.Results -Descriptive analysis revealed student test scores increased for both interventions, IL LOs and face-to-face. Test scores increased, on average, between 14 to 37%. In comparing posttests, results revealed a statistically significant difference only with the first topic, Finding Articles. In this case, the IL LOs (video) group outperformed the face-to-face group by at least 10%. No significance, in terms of performance from pre-and post-test scores, was found for the other two topics.Conclusion -Both IL LO and face-to-face library led workshop interventions had a positive impact on students' IL skill acquisition as evidenced by an overall increase in average test Evidence Based Library and Information Practice 2016, 11.2 52 scores. One IL LO on Finding Articles significantly outperformed the face-to-face class equivalent. Further study is needed to track individual student performance.

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