Background: The modified Ashworth scale (MAS) is the most widely used method for assessing muscle spasticity in clinical practice and research. However, the validity of this scale has been challenged. Objectives: To compare the MAS with objective neurophysiological tests of spasticity. Methods: The MAS was recorded in patients with post-stroke lower limb muscle spasticity and correlated with the excitability of the α motor neurones. The latter was evaluated by measuring the latency of the Hoffmann reflex (H reflex) and the ratio of the amplitude of the maximum H reflex (H max ) to that of the compound action motor potential of the soleus muscle (M max ). Results: Data on 24 randomly recruited patients were analysed. Patients were divided into two groups according to their MAS score: 14 had a MAS score of 1 (group A) and 10 scored 2 (group B). The two groups were comparable with respect to age and sex, but in group A there was a longer period since the stroke. The H reflex latency was reduced and the H max :M max ratio was increased in both groups. The H max :M max ratio values were higher for group B but the differences were not statistically significant. Conclusions: There is a relation between the MAS scores and α motor neurone excitability, although it is not linear. This suggests that the MAS measures muscle hypertonia rather than spasticity.

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Background: Evidence of climate change and its impact continues to be accumulated, and it is argued that the consequences of climate change are likely to result in an increased demand on health services. It has been claimed that climate change presents new challenges for health services and that strategies should be adopted to address these challenges. Aim:The aim of this systematic review was to map published literature on health, climate change and sustainability by categorising papers according to their focus on effects, strategy and actions, and to provide a thematic analysis of their content.Methods: Systematic searches were conducted via a range of healthcare related databases i.e. Pubmed, Medline, CINAHL, AMED, ASSIA, IBSS and ISI Web of Knowledge. Searches focussed upon papers published in English between 1998 and 2008. Retrieved papers were studied by the authors in order to inform the thematic analysis of their content.Results: A total of 114 publications were retrieved, of which 36 met the inclusion criteria for the systematic review. These 36 publications were categorised and are discussed according to their focus on: effects/impacts, strategy/policy, action/examples. Conclusions:A number of papers report the potential health effects of climate change while others report policies and strategies to tackle these effects. However there is an urgent need to identify and report on the implementation of strategies to mitigate and adapt to these challenges and to publish real examples of actions. Actions that are taken need to be evidence/policy based, and implementations monitored, evaluated and published.

Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can identify immunomodulatory therapies with strong beneficial effects in this group3. Here we analyse 24,202 cases of COVID-19 with critical illness comprising a combination of microarray genotype and whole-genome sequencing data from cases of critical illness in the international GenOMICC (11,440 cases) study, combined with other studies recruiting hospitalized patients with a strong focus on severe and critical disease: ISARIC4C (676 cases) and the SCOURGE consortium (5,934 cases). To put these results in the context of existing work, we conduct a meta-analysis of the new GenOMICC genome-wide association study (GWAS) results with previously published data. We find 49 genome-wide significant associations, of which 16 have not been reported previously. To investigate the therapeutic implications of these findings, we infer the structural consequences of protein-coding variants, and combine our GWAS results with gene expression data using a monocyte transcriptome-wide association study (TWAS) model, as well as gene and protein expression using Mendelian randomization. We identify potentially druggable targets in multiple systems, including inflammatory signalling (JAK1), monocyte–macrophage activation and endothelial permeability (PDE4A), immunometabolism (SLC2A5 and AK5), and host factors required for viral entry and replication (TMPRSS2 and RAB2A).

A single session of isokinetic or isotonic muscle stretch (with or without weight-bearing) of the ankle plantar flexors has no clinically observable effect on the gait of hemiplegic stroke patients.