Single people and homelessness: a sociological study of Durham Cyrenlans

This study is presented in two sections. The first Is about national and local housing issues and homelessness, providing contextual background for the history of Durham Cyrenlans, a small project providing accommodation and support for single homeless people. The second section is about the social processes experienced by residents, volunteer workers and management committee members as they join the project, become involved in it and leave it. The theoretical framework within which this study is set is that of the relationship between the centre and the periphery of society. The essence of the study is that homelessness is a socially created problem arising out of the centre periphery relationship, not one of inadequate people and it is suggested that it is with this understanding that change can be realised

Physical therapy and deep brain stimulation in Parkinson’s Disease: Protocol for a pilot randomized controlled trial

Abstract Background Subthalamic nucleus deep brain stimulation (STN-DBS) reduces tremor, muscle stiffness, and bradykinesia in people with Parkinson’s Disease (PD). Walking speed, known to be reduced in PD, typically improves after surgery; however, other important aspects of gait may not improve. Furthermore, balance may worsen and falls may increase after STN-DBS. Thus, interventions to improve balance and gait could reduce morbidity and improve quality of life following STN-DBS. Physical therapy (PT) effectively improves balance and gait in people with PD, but studies on the effects of PT have not been extended to those treated with STN-DBS. As such, the efficacy, safety, and feasibility of PT in this population remain to be determined. The purpose of this pilot study is to address these unmet needs. We hypothesize that PT designed to target balance and gait impairment will be effective, safe, and feasible in this population. Methods/design Participants with PD treated with STN-DBS will be randomly assigned to either a PT or control group. Participants assigned to PT will complete an 8-week, twice-weekly PT program consisting of exercises designed to improve balance and gait. Control group participants will receive the current standard of care following STN-DBS, which does not include prescription of PT. The primary aim is to assess preliminary efficacy of PT on balance (Balance Evaluation Systems Test). A secondary aim is to assess efficacy of PT on gait (GAITRite instrumented walkway). Participants will be assessed OFF medication/OFF stimulation and ON medication/ON stimulation at baseline and at 8 and 12 weeks after baseline. Adverse events will be measured over the duration of the study, and adherence to PT will be measured to determine feasibility. Discussion To our knowledge, this will be the first study to explore the preliminary efficacy, safety, and feasibility of PT for individuals with PD with STN-DBS. If the study suggests potential efficacy, then this would justify larger trials to test effectiveness and safety of PT for those with PD with STN-DBS. Trial registration NCT03181282 (clinicaltrials.gov). Registered on 7 June 2017

Association of the Sweet-Liking Phenotype and Craving for Alcohol With the Response to Naltrexone Treatment in Alcohol Dependence: A Randomized Clinical Trial

Identification of moderators of the response to naltrexone hydrochloride treatment for alcohol dependence could improve clinical care for patients with alcohol use disorders. To investigate the preliminary finding that the sweet-liking (SL) phenotype interacts with a high level of craving for alcohol and is associated with an improved response to naltrexone in alcohol dependence. This 12-week double-blind, randomized, placebo-controlled clinical trial was conducted from February 1, 2010, to April 30, 2012, in an academic outpatient medical center. Eighty actively drinking patients were randomized by the SL (n = 22) or the sweet-disliking (SDL) (n = 58) phenotype and by pretreatment high (n = 40) or low (n = 40) craving for alcohol, with high craving defined as greater than the median. Patients and staff were blinded to categorization. Patients were excluded for unstable medical or psychiatric illness, including dependence on drugs other than nicotine. Four patients (2 in the placebo arm and 2 in the naltrexone arm) stopped medication therapy because of adverse effects. Data were analyzed from January 15, 2013, to May 15, 2016, based on intention to treat. Oral naltrexone hydrochloride, 50 mg/d, or daily placebo with weekly to biweekly brief counseling. The a priori hypothesis tested SL/SDL phenotype, pretreatment craving, and their interaction as moderators of frequency of abstinent and heavy drinking days during treatment, assessed with the timeline follow-back method. Eighty patients were randomized (57 men [71%]; 23 women [29%]; mean [SD] age, 47.0 [8.6] years). A nonsignificant effect of naltrexone on heavy drinking was noted (4.8 fewer heavy drinking days; Cohen d = 0.45; 95% CI, -0.01 to 0.90; F1,67 = 3.52; P = .07). The SL phenotype moderated the effect of naltrexone on heavy drinking (6.1 fewer heavy drinking days; Cohen d = 0.58; 95% CI, 0.12-1.03; F1,67 = 5.65; P = .02) and abstinence (10.0 more abstinent days; Cohen d = 0.57; 95% CI, 0.11-1.02; F1,67 = 5.36; P = .02), and high craving moderated heavy drinking (7.1 fewer heavy drinking days; Cohen d = 0.66; 95% CI, 0.20-1.11; F1,67 = 7.37; P = .008). The combination of the SL phenotype and high craving was associated with a strong response to naltrexone, with 17.1 fewer heavy drinking days (Cohen d = 1.07; 95% CI, 0.58-1.54; F1,67 = 19.33; P < .001) and 28.8 more abstinent days (Cohen d = 0.72; 95% CI, 0.25-1.17; F1,67 = 8.73; P = .004) compared with placebo. The SL phenotype and a high craving for alcohol independently and particularly in combination are associated with a positive response to naltrexone. The SL/SDL phenotype and a high craving for alcohol merit further investigation as factors to identify patients with alcohol dependence who are responsive to naltrexone. clinicaltrials.gov Identifier: NCT01296646

Rates of ethanol metabolism decrease in sons of alcoholics following a priming dose of ethanol

Rapid changes in rates of ethanol metabolism in response to acute ethanol administration have been observed in animals and humans. To examine whether this phenomenon might vary by risk for alcoholism, 23 young men with a positive family history of alcoholism (FHP) were compared to 15 young men without a family history of alcoholism (FHN). Rates of ethanol metabolism were measured in all subjects first after an initial ethanol dose (0.85 g/kg) and then, several hours later, a second dose (0.3 g/kg), and the two rates were compared. The two groups of subjects were similar in their histories of ethanol consumption. FHP subjects demonstrated faster initial rates of ethanol metabolism, 148 ± 36 mg/kg/hr, compared to FHN subjects, 124 ± 18 mg/kg/hr, p=.01. However, FHN subjects increased their rate of metabolism by 10 ± 27 percent compared to a decrease of -15 ± 24 percent in FHP subjects, p =.007. Fifty-two percent of the FHP and none of the FHN subjects exhibited a decline in metabolic rate of 20% or more, p=.0008. Since a significant proportion of FHP subjects exhibited a decrease in the second rate of ethanol metabolism, these preliminary data might help to partly explain why FHP individuals differ in their sensitivity to ethanol and are more likely to develop alcohol dependence

Walk to the Beat: A Case Report of the Use of a Novel Haptic Device to Improve Walking after Stroke

Background: Stroke affects 15 million people worldwide every year and leaves two-thirds of survivors with significant mobility deficits including reduced walking speed, increased unevenness of step length and asymmetry. Haptic cues, which utilise sensory stimulation and so are unaffected by visual or auditory interference could discreetly improve the gait of people after stroke. Therefore, the objective of this single mixed methods case study was to evaluate the use of a novel haptic device in a single participant after stroke.Context and purpose: After initial familiarisation, gait symmetry, walking speed and cadence of a 69 year old male stroke survivor were recorded using a Qualisys Motion Capture system whilst he walked on a ten metre walkway, firstly without and then with a haptic device on each leg, which provided a metronomic rhythmical vibratory cue. The participant then provided a user evaluation of the devices using a semi structured interview.Results: The haptic device was evaluated positively by the participant although he noted it needed to be refined to increase its wear-ability and acceptability for everyday use. Whilst gait speed and cadence remained unaltered, there was a 14% improvement in temporal gait symmetry when wearing the haptic device, suggesting it improved this aspect of gait.Conclusion: Whilst limited by its design, the findings of this single case study indicate that the haptic device could be a novel technology-based therapeutic adjunct to improve gait symmetry after stroke. It also provides key understanding of user needs which can be used to guide the development of a new prototype device for stroke survivors.Brief summary: Many stroke survivors have residual mobility problems. Haptic cueing may improve walking by providing a tactile cue that the participant follows to improve symmetry. This single case study suggests that gait symmetry could be improved by haptic cueing and indicates factors affecting the wear ability of such a device.</br

A blended user centred design study for wearable haptic gait rehabilitation following hemiparetic stroke

Restoring mobility and rehabilitation of gait are high priorities for post-stroke rehabilitation. Cueing using metronomic rhythmic sensory stimulation has been shown to improve gait, but most versions of this approach have used auditory and visual cues. In contrast, we developed a prototype wearable system for rhythmic cueing based on haptics, which was shown to be highly effective in an early pilot study. In this paper we describe a follow-up study with four stroke survivors to inform design, and to identify issues and requirements for such devices to be used in home-based or out-door settings. To this end, we present a blended user-centred design study of a wearable haptic gait rehabilitation system. This study draws on the combined views of physiotherapists, nurses, interaction designers and stroke survivors. Many of the findings were unanticipated, identifying issues outside the scope of initial designs, with important implications for future design and appropriate use

Efficacy and Safety of Baclofen for Alcohol Dependence: A Randomized, Double-Blind, Placebo-Controlled Trial

Recent clinical trials and case-reports indicate that baclofen, a GABAB agonist, may have efficacy for alcohol dependence. Baclofen has been shown to enhance abstinence, to reduce drinking quantity, to reduce craving, and to reduce anxiety in alcohol dependent individuals in two placebo-controlled trials in Italy. However, the clinical trial data with baclofen is limited. The purpose of the present study was to test the efficacy and tolerability of baclofen in alcohol dependence in the United States

Additional file 2: of Physical therapy and deep brain stimulation in Parkinson’s Disease: protocol for a pilot randomized controlled trial

Physical therapy for deep brain stimulation: home exercise program. (DOCX 14 kb

Additional file 1: of Physical therapy and deep brain stimulation in Parkinson’s Disease: protocol for a pilot randomized controlled trial

Physical therapy for deep brain stimulation: in-clinic treatment program. (DOCX 35 kb