The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy : a systematic review and economic evaluation

Peer reviewedPublisher PD

A Reusable, Extensible Infrastructure for Augmented Field Trips

This paper describes a reusable pervasive information infrastructure developed as part of the Equator IRC, designed to allow the construction of literacy based eLearning activities on top of material created as part of a more traditional visitors system. The architecture of the system is described along with details of the creation of the curated material and the subsequent adaption of the system by local primary school teachers to create a literacy experiences. Results of the first trials of the system are presented with conclusions drawn and discussion of future directions

The Literacy Fieldtrip: Using UbiComp to Support Children's Creative Writing

Fieldtrips, traditionally associated with science, history and geography teaching, have long been used to support children’s learning by allowing them to engage with environments first-hand. Recently, ubiquitous computing (UbiComp) has been used to enhance fieldtrips in these educational areas by augmenting environments with a range of instruments, devices and sensors. However, the sorts of interaction design that UbiComp makes possible have the potential not just to enhance the value of educational techniques in known application areas, but also to expand the application of those techniques into new areas of curriculum. We report on a UbiComp-supported fieldtrip to support creative writing, associated with the learning of literacy skills. We discuss how the fieldtrip, designed and run in the grounds of a historic English country house with Year 5 UK schoolchildren, engendered interactions which changed both the processes and products of creative writing, with benefits for both teachers and children

UbiComp in Opportunity Spaces: Challenges for Participatory Design

The rise of ubiquitous computing (UbiComp), where pervasive, wireless and disappearing technologies offer hitherto unavailable means of supporting activity, increasingly opens up ‘opportunity spaces’. These are spaces where there is no urgent problem to be solved, but much potential to augment and enhance practice in new ways. Based on our experience of co-designing novel user experiences for visitors to an English country estate, we discuss challenges for PD in such an opportunity space. Key amongst these are how to build a working relationship of value when there are no urgent requirements; how to understand and scope the space of opportunities; and how to leave users with new resources of value to them

A persistent infrastructure for augmented field trips

This paper describes an approach to the provision of pervasive field trips where a persistent infrastructure is provided, upon which teachers can easily create novel pervasive experiences for children. The physical infrastructure is briefly described along with the underlying information infrastructure, which enables the tools for authoring the content and designing the orchestration of the experience to be placed in the hands of teachers. A literacy experience and initial trials of the system are discussed, conclusions drawn, and future directions outlined

Is self-monitoring an effective option for people receiving long-term vitamin K antagonist therapy? A systematic review and economic evaluation

OBJECTIVES: To investigate the clinical and cost-effectiveness of self-monitoring of coagulation status in people receiving long-term vitamin K antagonist therapy compared with standard clinic care. DESIGN: Systematic review of current evidence and economic modelling. DATA SOURCES: Major electronic databases were searched up to May 2013. The economic model parameters were derived from the clinical effectiveness review, routine sources of cost data and advice from clinical experts. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) comparing self-monitoring versus standard clinical care in people with different clinical conditions. Self-monitoring included both self-management (patients conducted the tests and adjusted their treatment according to an algorithm) and self-testing (patients conducted the tests, but received treatment recommendations from a clinician). Various point-of-care coagulometers were considered. RESULTS: 26 RCTs (8763 participants) were included. Both self-management and self-testing were as safe as standard care in terms of major bleeding events (RR 1.08, 95% CI 0.81 to 1.45, p=0.690, and RR 0.99, 95% CI 0.80 to 1.23, p=0.92, respectively). Self-management was associated with fewer thromboembolic events (RR 0.51, 95% CI 0.37 to 0.69, p </= 0.001) and with a borderline significant reduction in all-cause mortality (RR 0.68, 95% CI 0.46 to 1.01, p=0.06) than standard care. Self-testing resulted in a modest increase in time in therapeutic range compared with standard care (weighted mean difference, WMD 4.4%, 95% CI 1.71 to 7.18, p=0.02). Total health and social care costs over 10 years were pound7324 with standard care and pound7326 with self-monitoring (estimated quality adjusted life year, QALY gain was 0.028). Self-monitoring was found to have approximately 80% probability of being cost-effective compared with standard care applying a ceiling willingness-to-pay threshold of pound20,000 per QALY gained. Within the base case model, applying the pooled relative effect of thromboembolic events, self-management alone was highly cost-effective while self-testing was not. CONCLUSIONS: Self-monitoring appears to be a safe and cost-effective option. TRIAL REGISTRATION NUMBER: PROSPERO CRD42013004944

Blaming Bill Gates AGAIN! Misuse, overuse and misunderstanding of performance data in sport

Recently in Sport, Education and Society, Williams and Manley (2014) argued against the heavy reliance on technology in professional Rugby Union and elite sport in general. In summary, technology is presented as an elitist, ‘gold standard’ villain that management and coaches use to exert control and by which players lose autonomy, identity, motivation, social interactions and expertise. In this article we suggest that the sociological interpretations and implications offered by Williams and Manley may be somewhat limited when viewed in isolation. In doing so, we identify some core methodological issues in Williams and Manley’s study and critically consider important arguments for utilising technology; notably, to inform coach decision making and generate player empowerment. Secondly, we present a different, yet perhaps equally concerning, practice-oriented interpretation of the same results but from alternative coaching and expertise literature. Accordingly, we suggest that Williams and Manley have perhaps raised their alarm prematurely, inappropriately and on somewhat shaky foundations. We also hope to stimulate others to consider contrary positions, or at least to think about this topic in greater detail. More specifically, we encourage coaches and academics to think carefully about what technology is employed, how and why, and then the means by which these decisions are discussed with and, preferably, sold to players. Certainly, technology can significantly enhance coach decision making and practice, while also helping players to optimise their focus, empowerment and independence in knowing how to achieve their personal and collective goals

Larotrectinib efficacy and safety in TRK fusion cancer: An expanded clinical dataset showing consistency in an age and tumor agnostic approach

Background: TRK fusion cancer results from gene fusions involving NTRK1, NTRK2 or NTRK3. Larotrectinib, the first selective TRK inhibitor, has demonstrated an overall response rate (ORR) of 75% with a favorable safety profile in the first 55 consecutively enrolled adult and pediatric patients with TRK fusion cancer (Drilon et al.,NEJM2018). Here, we report the clinical activity of larotrectinib in an additional 35 TRK fusion cancer patients and provide updated follow-up of the primary analysis set (PAS) of 55 patients as of 19thFeb 2018. Methods: Patients with TRK fusion cancer detected by molecular profiling from 3 larotrectinib clinical trials (NCT02122913, NCT02637687, and NCT02576431) were eligible.Larotrectinib was administered until disease progression, withdrawal, or unacceptable toxicity. Disease status was assessed using RECIST version 1.1. Results: As of Feb 2018, by independent review, 6 PRs in the PAS deepened to CRs. The median duration of response (DoR) and progression-free survival in the PAS had still not been reached, with 12.9 months median follow-up. At 1 year, 69% of responses were ongoing, 58% of patients remained progression-free and 90% of patients were alive. An additional 19 children and 25 adults (age range, 0.1-78 years) with TRK fusion cancer were enrolled after the PAS, and included cancers of the salivary gland, thyroid, lung, colon, melanoma, sarcoma, GIST and congenital mesoblastic nephroma. In 35 evaluable patients, the ORR by investigator assessment was 74% (5 CR, 21 PR, 6 SD, 2 PD, 1 not determined). In these patients, with median follow-up of 5.5 months, median DoR had not yet been reached, and 88% of responses were ongoing at 6 months, consistent with the PAS. Adverse events (AEs) were predominantly grade 1, with dizziness, increased AST/ALT, fatigue, nausea and constipation the most common AEs reported in ≥ 10% of patients. No AE of grade 3 or 4 related to larotrectinib occurred in more than 5% of patients. Conclusions: TRK fusions are detected in a broad range of tumor types. Larotrectinib is an effective age- and tumor-agnostic treatment for TRK fusion cancer with a positive safety profile. Screening patients for NTRK gene fusions in solid- and brain tumors should be actively considered

Selective in vitro replication of herpes simplex virus type 1 (HSV-1) ICP34.5 null mutants in primary human CNS tumours--evaluation of a potentially effective clinical therapy.

Primary tumours of the central nervous system (CNS) are an important cause of cancer-related deaths in adults and children. CNS tumours are mostly glial cell in origin and are predominantly astrocytomas. Conventional therapy of high-grade gliomas includes maximal resection followed by radiation treatment. The addition of adjuvant chemotherapy provides little improvement in survival time and hence assessment of novel therapies is imperative. We have evaluated the potential therapeutic use of the herpes simplex virus (HSV) mutant 1716 in the treatment of primary brain tumours. The mutant is deleted in the RL1 gene and fails to produce the virulence factor ICP34.5. 1716 replication was analysed in both established human glioma cell lines and in primary cell cultures derived from human tumour biopsy material. In the majority of cultures, virus replication occurred and consequential cell death resulted. In the minority of tumour cell lines which are non-permissive for mutant replication, premature shut-off of host cell protein synthesis was induced in response to lack of expression of ICP34.5. Hence RL1-negative mutants have the distinct advantage of providing a double hit phenomenon whereby cell death could occur by either pathway. Moreover, 1716, by virtue of its ability to replicate selectively within a tumour cell, has the potential to deliver a 'suicide' gene product to the required site immediately. It is our opinion that HSV which fails to express ICP34.5 could provide an effective tumour therapy