Using Technology in the Assessment and Rehabilitation of Spatial Neglect

Spatial neglect is characterised by inattention to stimuli in the contralesional side of space. The complexity of the condition (manifesting in personal, near, and far space) make it difficult to assess, with some subtypes not commonly assessed. And, due to the low quality of the current evidence, no single intervention can be formally recommended to effectively rehabilitate neglect. However, technology may offer an opportunity to improve the sensitivity of assessments and facilitate self-administration of rehabilitation at home. In Chapter 1, results from 179 healthy adults (aged 18-94 years-old) revealed that performance on the Computerised Extrapersonal Neglect Test (CENT)’s visuospatial tasks (cancellation, line bisection) were related, sensitive to age-related decline, and sex differences in extrapersonal (far) space. Age-graded normative data was produced to inform the detection of spatial neglect in extrapersonal space in stroke survivors. Chapter 2 found CENT’s cancellation test had excellent diagnostic accuracy, sensitivity and validity compared to the widely used, validated paper-and-pencil neglect tests. In a group of 57 stroke survivors, CENT identified 18 cases of extrapersonal neglect which would otherwise go undetected. The results demonstrate the capabilities of a computerised assessment in providing additional attentional measures, as well as the necessity of carrying out a comprehensive assessment of neglect subtypes to inform rehabilitation strategies. Finally, Chapter 3 found that it was feasible for NHS staff to set-up and train 7 participants to self-administer the computerised Spatial Inattention Grasping Home-based Therapy (c-SIGHT) intervention. Though the sample was small and underpowered, there was preliminary evidence of the positive effects of c-SIGHT. This trial demonstrates the value of feasibility studies in providing recommendations to inform future studies. Together these studies offer practical recommendations and novel findings demonstrating the usefulness of technology in detecting spatial neglect and delivering rehabilitation at home to better support and improve people’s lives after stroke

Practitioner perspectives on the application of palaeoecology in nature conservation

It is widely recognised that palaeoecology holds great potential to inform and support nature conservation, but that there are difficulties in knowledge exchange between academia and practitioners that inhibit the operationalisation of research. To facilitate the integration of palaeoecology into the conservation toolkit, it is essential to understand perspectives of the practitioners themselves and the contexts in which they work. This paper reports the results of a survey of 153 UK-based conservation practitioners, concerning their perceptions of palaeoecology, the barriers to its use and potential solutions for making palaeoecological insights more accessible in conservation practice. The survey was conducted online over a period of 3 months; closed question responses were analysed for statistical trends and thematic analysis was done on open question responses. The majority of respondents were strongly positive about the role palaeoecological research could play, though they also exhibited a limited understanding of how and why one might implement it. They identified time constraints as the biggest barrier to using palaeoecology within their work, and also flagged concerns around financial resources and the accessibility of the research. Access to applied case studies and a centralised database were the most favoured solutions among respondents. Respondents with prior experience of working with palaeoecology were generally more optimistic about its incorporation. This paper makes several key recommendations to progress the integration of palaeoecology into conservation, including improving data accessibility, aligning research design with conservation and policy drivers, and increasing both respective groups’ understanding of the other

Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke

Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable therapies and remotely monitor adherence without the presence of a therapist at all times. Researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and, ultimately, optimize adherence and efficacy. This study aims to explore end-user perspectives on the use of self-administered VR for spatial neglect in a university environment to identify barriers and facilitators prior to extending its use remotely as a telerehabilitation tool. We used a mixed-method design including focus groups, self-administered questionnaires and interviews with stroke survivors (N = 7), their carers (N = 3) and stroke clinicians (N = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators were performance feedback, engagement and enjoyment, and psychological benefits associated with self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform development, enhance engagement and uptake of VR telerehabilitation and inform future studies

A novel in vitro 3D model of the human bone marrow to bridge the gap between in vitro and in vivo genotoxicity testing

The regulatory 2D in vitro micronucleus (MN) assay is part of a battery of tests, used to test for genotoxicity of new and existing compounds before they are assessed in vivo (ICH S2). The 2D MN assay consists of a monolayer of cells, whereas the in vivo bone marrow (BM) setting comprises a multicellular environment within a three-dimensional extracellular matrix. Although the in vitro MN assay follows a robust protocol set out by the Organisation for Economic Co-operation and Development (OECD) to comply with regulatory bodies, some compounds have been identified as negative genotoxicants within the in vitro MN assay but marginally positive when assessed in vivo. The glucocorticoids, which are weakly positive in vivo, have generally been suggested to pose no long-term carcinogenic risk; however, for novel compounds of unknown activity, improved prediction of genotoxicity is imperative. To help address this observation, we describe a novel 3D in vitro assay which aims to replicate the results seen within the in vivo BM microenvironment. AlgiMatrix scaffolds were optimized for seeding with HS-5 human BM stromal cells as a BM microenvironment, to which the human lymphoblast cell line TK6 was added. An MN assay was performed aligning with the 2D regulatory assay protocol. Utilizing this novel 3D in vitro model of the BM, known genotoxicants (mitomycin C, etoposide, and paclitaxel), a negative control (caffeine), and in vivo positive glucocorticoids (dexamethasone and prednisolone) were investigated for the induction of MN. It was found, in agreement with historical in vivo data, that the model could accurately predict the in vivo outcome of the glucocorticoids, unlike the regulatory 2D in vitro MN assay. These preliminary results suggest our 3D MN assay may better predict the outcome of in vivo MN tests, compared with the standard 2D assay

Practitioner perspectives on the application of palaeoecology in nature conservation

It is widely recognised that palaeoecology holds great potential to inform and support nature conservation, but that there are difficulties in knowledge exchange between academia and practitioners that inhibit the operationalisation of research. To facilitate the integration of palaeoecology into the conservation toolkit, it is essential to understand perspectives of the practitioners themselves and the contexts in which they work. This paper reports the results of a survey of 153 UK-based conservation practitioners, concerning their perceptions of palaeoecology, the barriers to its use and potential solutions for making palaeoecological insights more accessible in conservation practice. The survey was conducted online over a period of 3 months; closed question responses were analysed for statistical trends and thematic analysis was done on open question responses. The majority of respondents were strongly positive about the role palaeoecological research could play, though they also exhibited a limited understanding of how and why one might implement it. They identified time constraints as the biggest barrier to using palaeoecology within their work, and also flagged concerns around financial resources and the accessibility of the research. Access to applied case studies and a centralised database were the most favoured solutions among respondents. Respondents with prior experience of working with palaeoecology were generally more optimistic about its incorporation. This paper makes several key recommendations to progress the integration of palaeoecology into conservation, including improving data accessibility, aligning research design with conservation and policy drivers, and increasing both respective groups’ understanding of the other

A qualitative study exploring hand hygiene practices in a neonatal unit in Blantyre, Malawi: implications for controlling healthcare-associated infections

Background: Neonatal sepsis is responsible for a considerable burden of morbidity and mortality in sub-Saharan African countries. Outcomes from neonatal sepsis are worsening due to increasing rates of antimicrobial resistance. Sub-optimal Infection Prevention and Control (IPC) practices of health care workers and caregivers are important drivers of infection transmission. The Chatinkha Neonatal Unit at Queen Elizabeth Central Hospital, Blantyre, Malawi has experienced multiple outbreaks of neonatal sepsis, associated with drug resistant Klebsiella pneumoniae. We aimed to understand the barriers to implementation of optimal IPC focusing on hand hygiene practice. Methods: We used a qualitative research methodology to meet the study aim. Combining participant observation (PO) over a seven-month period with semi structured interviews (SSI) to provide an in-depth understanding of activities relating to hygiene and IPC existing on the ward. Results: While most staff and some caregivers, had a good understanding of ideal IPC and understood the importance of good handwashing practices, they faced substantial structural limitations, and scarce resources (both material and human) which made implementation challenging. For staff, the overwhelming numbers of patients meant the workload was often unmanageable and practicing optimal IPC was challenging. Caregivers lacked access to basic amenities, including linen and chairs, meaning that it was almost impossible for them to maintain good hand hygiene. Limited access to soap and the erratic water supply for both caregivers and healthcare workers further worsened the situation. Communication challenges between different cadres of staff and with patient caregivers meant that those handling neonates and cleaning the wards were often unaware of outbreaks of drug resistant infection. Conclusion: For IPC to be improved, interventions need to address the chronic shortages of material resources and create an enabling environment for HCWs and patient caregivers

A qualitative study exploring health workers and patient caregivers' hand hygiene practices in a neonatal unit in Blantyre, Malawi, implications for controlling outbreaks of drug resistant infections

Background: Neonatal sepsis is responsible for a considerable burden of morbidity and mortality in sub-Saharan African countries. Outcomes from neonatal sepsis are worsening due to increasing rates of antimicrobial resistance. Sub-optimal Infection Prevention and Control (IPC) practices of health care workers and caregivers are important drivers of infection transmission. The Chatinkha Neonatal Unit at Queen Elizabeth Central Hospital, Blantyre, Malawi has experienced multiple outbreaks of neonatal sepsis, associated with drug resistant Klebsiella pneumoniae. We aimed to understand the barriers to implementation of optimal IPC focusing on hand hygiene practice. Methods: We used a qualitative research methodology to meet the study aim. Combining participant observation (PO) over a seven-month period with semi structured interviews (SSI) to provide an in-depth understanding of activities relating to hygiene and IPC existing on the ward. Results: While most staff and some caregivers, had a good understanding of ideal IPC and understood the importance of good handwashing practices, they faced substantial structural limitations, and scarce resources (both material and human) which made implementation challenging. For staff, the overwhelming numbers of patients meant the workload was often unmanageable and practicing optimal IPC was challenging. Caregivers lacked access to basic amenities, including linen and chairs, meaning that it was almost impossible for them to maintain good hand hygiene. Limited access to soap and the erratic water supply for both caregivers and healthcare workers further worsened the situation. Communication challenges between different cadres of staff and with patient caregivers meant that those handling neonates and cleaning the wards were often unaware of outbreaks of drug resistant infection. Conclusion: For IPC to be improved, interventions need to address the chronic shortages of material resources and create an enabling environment for HCWs and patient caregivers

Reporting HIV in Papua New Guinea: Trends and Omissions from 2000 to 2010

This article presents the findings from a longitudinal content analysis on the reporting of HIV (Human Immunodeficiency Virus) in Papua New Guinea’s two national newspapers—The National and Post-Courier—in 2000, 2005 and 2010. The authors tried to answer two key questions: Did press coverage of the disease increase and did the topics change or remain the same? Data from the content analysis showed that coverage of the disease increased significantly during the ten-year study period, and that the framing of the disease moved beyond representing HIV as purely a health story to one that was linked to socio-economic conditions and cultural practices. The feature stories gradually showed more sensitivity to people living with HIV, while they recognised and challenged the social stigma still associated with the disease in much of the countr