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Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial
Data availability statement:
Data are available upon reasonable request. Data will be made available on the Figshare data repository.Objective: To investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.
Design: A feasibility randomised controlled trial with a parallel process evaluation.
Setting: Acute Stroke Unit and participants’ homes (London, UK).
Participants: 24 adults (>18 years), acute and subacute poststroke, new unilateral weakness, scoring 9–25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate.
Interventions: Participants randomised to the intervention or control group on a 2:1 ratio. The intervention group (n=16) received usual care plus the Neurofenix platform for 7 weeks. The control group (n=8) received usual care only.
Outcomes: Safety was assessed through adverse events (AEs), pain, spasticity and fatigue. Feasibility was assessed through training and support requirements and intervention fidelity. Acceptability was assessed through a satisfaction questionnaire. Impairment, activity and participation outcomes were also collected at baseline and 7 weeks to assess their suitability for use in a definitive trial.
Randomisation: Computer-generated, allocation sequence concealed by opaque, sealed envelopes.
Blinding: Participants and assessors were not blinded; statistician blinded for data processing and analysis.
Results: 192 stroke survivors were screened for eligibility, and 24 were recruited and randomised. Intervention group: n=16, mean age 66.5 years; median 9.5 days post stroke. Control group: n=8, mean age 64.6 years; median 17.5 days post stroke. Three participants withdrew before the 7-week assessment, n=21 included in the analysis (intervention group n=15; control group n=6). No significant group differences in fatigue, spasticity, pain scores or total number of AEs. The median (IQR) time to train participants was 98 (64) min over 1–3 sessions. Participants trained with the platform for a median (range) of 11 (1-58) hours, equating to 94 min extra per week. The mean satisfaction score was 34.9 out of 40.
Conclusion: The Neurofenix platform is safe, feasible and well accepted as an adjunct to usual care in acute and subacute stroke rehabilitation. There was a wide range of engagement with the platform in a cohort of stroke survivors which was varied in age and level of impairment. Recruitment, training and support were manageable and completion of data was good, indicating that a future randomised controlled trial would be feasible.
Trial registration number: ISRCTN11440079.This work was supported by The Stroke Association and MedCity grant number SA MC 21\10001
Applying Digital Spatial Profiling of the Transcriptome to Elucidate Disease Mechanisms of Psychosis in Alzheimer’s disease
Background:
Psychosis occurs in 30-40% of individuals with AD. New insights into disease mechanisms may lead to novel pharmacological targets and treatments. Previous studies have focused on bulk tissue analysis with limited results. Digital spatial profiling (DSP) is a new technique for spatial analysis of RNA or proteins in fixed tissue. It allows quantitative profiling with spatial complexity to be collected from samples in a non-destructive manner. In this pilot study we used DSP to compare whole transcriptome data in amyloid beta and non-amyloid beta regions in participants with and without psychosis (AD+P; AD-P).
Method:
Six post-mortem brain samples from prefrontal cortex were provided by the Kings College London Brains for Dementia Research (BDR) brain bank. Frozen and formalin fixed, paraffin embedded (FFPE) sections were supplied in order to test the platform on each type. Psychosis positive and negative groups were selected based on Neuropsychiatric Inventory (NPI) assessments. Samples were hematoxylin and eosin (H&E) stained as well as stained with fluorescent antibodies for AT8, NeuN, SYTO13 and Aβ. Regions of interest (ROIs) are selected based on morphology markers and tissue morphology (see Figure 1 for Amyloid ROI selection).
Result:
H&E staining revealed the frozen samples to be too badly degraded so the analysis was conducted on FFPE sections. AT8 staining showed widespread tau pathology to the extent that it was not possible to confidently select non-tau ROIs. Analysis of Aβ plaque containing and Aβ plaque free regions, comparing AD+P and AD-P groups, found 314 differentially expressed genes in plaque free regions, and 172 differentially expressed genes in plaque containing regions (Figure 2). Of these 172 genes, 28 were not differentially expressed in plaque free regions, forming a plaque-specific signature of genes differentially expressed in AD+P.
Conclusion:
This pilot study demonstrates the potential of the NanoString GeoMx™ DSP platform as an innovative spatial transcriptomics methodology for investigating AD+P with the potential to uncover differentially expressed genes that may be missed by bulk RNA sequencing studies. FFPE sections appear to be optimal. Analysing earlier stage disease and more sections per subject may help with better differentiation of tau and non-tau ROIs
Psychoanalysis In Search of Itself: Jacques Lacan, T. S. Eliot, and the Seductions of Modernism
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The (non)integration of social identity demands and implicit leadership expectations: A challenge for professional hybrids
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The Keeper of Paintings at the National Gallery, London: Co-Designing an Immersive Experience in Art with and for Children
...UKRI Arts & Humanities Research Council ref: AH/T011394/1 (StoryFutures China: UK-China Transnational Strategic Partnership for Immersive Storytelling in Museums and Cultural Institutions)
Does the Market React to Greenwashing? The Impact of Alignment Between ESG Disclosure and ESG Performance on Capital Markets
Data Availability. From public sources...
‘Surviving carelessness and disposability in British higher education: The gendered and racialized emotional labours of academic migration
...No funding received to support the work presented in this paper
Regulating NFT marketplaces: a comparative analysis of the EU and UK legal systems
...other eds. DiMatteo/Hufnagel