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AbstractThe aim of this pilot study is to obtain estimates for the change in maternal cerebrovascular (primary) and offspring vascular structure (secondary) during healthy pregnancy that includes structured exercise. Eighteen pregnant women self-assigned to a moderate-intensity aerobic exercise intervention or a control group. Maternal cerebral blood flow (CBF) at the middle cerebral artery, cerebro- and peripheral-vascular function was assessed at the end of each trimester. Offspring carotid artery intima-media thickness (IMT) was measured within 12 weeks of birth. For exploratory purposes, we performed statistical analysis to provide estimates of the change for primary and secondary outcome variables. Maternal CBF reduced (− 8 cm s−1[− 14 to − 2]) with evidence of change to cerebral autoregulation (normalised gain: 0.12 %cm s−1% mmHg−1mmHg/% [− 0.18 to 0.40]) during pregnancy. Offspring carotid IMT was smaller in the exercise group (− 0.04 mm [− 0.12–0.03]) compared with controls. Based upon this data, a sample size of 33 and 57 in each group is required for low-frequency normalised gain and offspring IMT, respectively. This would provide 90% power to detect statistically significant (P < 0.05) between group differences in a randomised controlled trial. CBF is reduced in pregnancy, possibly due to reduced vascular resistance and altered maternal cerebral autoregulation. Maternal exercise had negligible effects on cerebrovascular adaptation to pregnancy, but we observed lower offspring carotid artery wall thickness following maternal exercise. Our directional findings and sample size estimations should be explored in a fully powered randomised control trial.Clinical trial registration: The trial was registered on March 14th athttps://register.clinicaltrials.gov(NCT03079258). Participant enrolment began on 3rd April 2016.

It is claimed that blindness may predispose individuals to disturbed sleep because light is an important mechanism for entraining circadian rhythms. One in five respondents in a survey described the quality of their sleep as either poor or very poor. Exercise was associated with better sleep, and depression with poorer sleep. That visual acuity did not predict the quality of sleep casts doubt on the notion that restricted visual (photic) input is a widespread cause of sleep disturbance among persons who are visually impaired. As with sighted persons, depression appears to be a highly significant risk factor for disturbed sleep in persons who are visually impaired.

Purpose
This paper aims to set out to share the reflections of safeguarding adult board managers as they worked through what is likely to be just the first wave of the coronavirus COVID-19 pandemic.


Design/methodology/approach
The paper draws on the experience of small number of safeguarding adult board managers who have provided reflections from practice.


Findings
This paper illustrates just some of the responses developed by safeguarding adult board managers and their boards to continue to deliver the work of safeguarding those at risk of abuse and harm in the face of unprecedented impact of the coronavirus COVID-19 pandemic on a key aspect of the safeguarding adult system in England.


Originality/value
The reflections reported here are not intended to offer a representative commentary on the experiences of those who oversee and manage safeguarding adults' boards. It is intention to provide a flavour of some of the challenges and dilemmas faced and some of the creative solutions to address them used by one group of adult safeguarding practitioners.

For use in the schools and by civic organizations . Planned to accompany "Metropolitan Los Angeles: one community" [by Mellier Goodin Scott]. ; Prepared and published under the direction of the John Randolph Haynes and Dora Haynes Foundation. ; Bibliography: p. 206-209. ; Mode of access: Internet.

The first step of effective health and social care is always to accurately identify your client's needs. This theoretically informed guide will show you how to enhance and apply your observation skills as required by the College of Social Work in a variety of challenging health and social settings with children, families and adults