IntroductionPoor medication adherence is common in children and adolescents with chronic illness, but there is uncertainty about the best way to enhance medication adherence in this group. The authors conducted a systematic review of controlled trials examining interventions that aim to improve medication adherence. Method A comprehensive literature search was undertaken to locate controlled trials that described specifi c interventions aiming to improve adherence to long-term medication, where participants were aged 18 years and under, medication adherence was reported as an outcome measure, and which could be implemented by individual health practitioners. Studies were reviewed for quality and outcome. Results 17 studies met inclusion criteria: seven studies examined educational strategies, seven studies examined behavioural interventions and three studies examined educational intervention combined with other forms of psychological therapies. Only two of seven studies reported a clear benefi t for education on medication adherence, whereas four of seven trials indicated a benefi t of behavioural approaches on medication adherence. One trial reported that combining education with behavioural management may be more effective than education alone. Studies which combined education with other non-medication specifi c psychological interventions failed to demonstrate a benefi cial effect on medication adherence. Only two studies examined adherencepromoting interventions in young people with established adherence problems. Conclusion These fi ndings suggest that education interventions alone are insuffi cient to promote adherence in children and adolescents, and that incorporating a behavioural component to adherence interventions may increase potential effi cacy. Future research should examine interventions in high-risk groups. INTRODUCTIONAdherence has been defi ned as 'the extent to which a person's behaviour corresponds with agreed recommendations from a healthcare provider'. 1 Medication adherence refers to the degree to which the medications taken refl ect the prescriber's intention. 2 3 Poor medication adherence is common, especially in chronic illness, 1 3 4 and is associated with poorer outcomes. 3 5 6 Interventions to promote adherence may be effective, although benefi ts are not consistently demonstrated across studies. 4 A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness Angela J Dean, 1-3 Julie Walters, 4 Anthony Hall 4,5Most existing reviews of adherence-promoting interventions have focused on adults. However, many young people experience chronic illness 7 8 and poor medication adherence. 9-12 Involvement of families in medication routines, 12 13 and varying developmental capacities of children and adolescents 11 12 14 15 may infl uence medication adherence, reinforcing the need to identify interventions with demonstrated effi cacy in young people rather than translating fi ndings from adult research. 9 11 A review of interven...

® T t STUDY DESIGN: Systematic review. T t BACKGROUND: Despite improvements inself-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. T t OBJECTIVE:To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. T t METHODS:Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer-and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. T t RESULTS:Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. T t CONCLUSION:The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA undertaken after THA and TKA. Registered with PROSPE-RO (registration number CRD42014010155). T t LEVEL OF EVIDENCE:Therapy, level 2a.

The literature suggests that while there is insufficient evidence to strongly advocate for the use of dry needling, it may be a useful addition to conventional physiotherapy in headache management. Further research with a stronger methodological design is required.

We use the Chandra X-ray Observatory to analyze interactions of the blast wave and the inhomogeneous interstellar medium on the western limb of the Cygnus Loop supernova remnant. This field of view includes an initial interaction between the blast wave and a large cloud, as well as the encounter of the shock front and the shell that surrounds the cavity of the supernova progenitor. Uniquely, the X-rays directly trace the shock front in the dense cloud, where we measure temperature kT = 0.03 keV. We find kT ≈ 0.2 keV in regions where reflected shocks further heat previously-shocked material. Applying onedimensional models to these interactions, we determine the original blast wave velocity v bw ≈ 330 km s −1 in the ambient medium. We do not detect strong evidence for instabilities or non-equilibrium conditions on the arcsecond scales we resolve. These sensitive, high-resolution data indicate no exceptional abundance variations in this region of the Cygnus Loop.

There is low quality evidence to suggest that walking is as effective as other non-pharmacological management methods at improving disability, function, and quality of life in adults with chronic low back pain.