This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.

More TBI-VR participants returned to work than UC. People with moderate/severe TBI benefitted most. This positive trend was achieved without greatly increased health costs, suggesting cost-effectiveness. This study justifies the need for and can inform a definitive Randomized Controlled Trial (RCT).

First metatarsophalangeal (MTP) joint reaction forces were calculated for 11 normal females during the toe-off phase of gait while walking in bare feet and in high heeled shoes. A biomechanical model was used to calculate the forces utilizing kinematic, kinetic, footprint, and radiographic data. The results showed that the MTP joint reaction forces (FJ), the metatarsal-sesamoid forces (FS), and the resultant of these forces (FRES), were twice as large in high heels compared to barefoot walking. The average peak forces for barefoot and high-heeled gait were FJ: 0.8 and 1.58 times body weight, FS: 0.44 and 1.03 times body weight, and FRES: 0.93 and 1.88 times body weight. Also, the kinematics changed when wearing high heels, making angles of application of forces and sesamoidal articulations less favorable.

Returning to work is a major goal for people following traumatic brain injury (TBI) (Wagner et al 2002, Kuipers et al 2003, Walker et al 2006). A systematic review of employment rates after acquired brain injury concluded that the average employment rate was 41% at one year (van Velzen et al 2009), that is, consistently lower than pre-injury rates (Grosswasser et al 1999, Catalano et al 2006). As TBI results in cognitive, psychological and physical problems, it is not surprising that there are difficulties with post-injury employment. Vocational rehabilitation is a 'process whereby those disadvantaged by illness or disability can be enabled to access, maintain or return to employment' (British Society of Rehabilitation Medicine 2003a, p1). It is also a quality requirement of the National Service Framework for Long-Term Conditions (Department of Health 2005). For people with TBI, vocational rehabilitation involves helping the person and others, such as work colleagues, to understand and cope with how the physical, cognitive and psychological consequences affect the ability to work (British Society of Rehabilitation Medicine et al 2004). Although research suggests that vocational rehabilitation can increase post-injury TBI employment rates, the actual mechanisms for this are unclear (Ownsworth and McKenna 2004). Within TBI vocational rehabilitation, there is little consensus about who should deliver it, how it should be delivered or what works best

ENT-UK recommends that when treating a patient with a discharging ear, in whom there is a perforation or patent grommet: if a topical aminoglycoside is used, this should only be in the presence of obvious infection. Topical aminoglycosides should be used for no longer than 2 weeks. The justification for using topical aminoglycosides should be explained to the patient. Baseline audiometry should be performed, if possible or practical, before treatment with topical aminoglycosides.

The increase in the prevalence of overweight and obesity in both developed and developing countries is associated with musculoskeletal and other non-communicable diseases. To address this, an accurate measure of body adiposity, bearing in mind several shortcomings of body mass index (BMI), should be used. This study determined the relationship between BMI and body fat (BF)% among adult Nigerians of different ethnic groups residing in an urban setting. Using multistage cluster sampling technique were recruited 1571 subjects (>18 years; male=51.2%) in a cross-sectional study. Body adiposity indices were assessed using BMI and BF%. Using BF%, the result shows that a total number of 156 (9.9%) had low BF% while 291 (18.5%) had very high BF%, while the BMI classifications of body adiposity, 68 (4.3%) were underweight while 271 (17.3%) were obese. There was a strong and positive statistical relationship between BF% and BMI when both were paired without controlling for gender and age (r=0.81, P<0.01). The results show that there is a strong positive association between BMI and BF%, and age and sex are predictors of this association.

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