Results from a randomised controlled pilot study of the Better Conversations with Primary Progressive Aphasia (BCPPA) communication partner training program for people with PPA and their communication partners

BACKGROUND: There has been a growing focus on functional communication interventions for primary progressive aphasia (PPA). These interventions aim to support individuals to participate in life situations. One such intervention, communication partner training (CPT) aims to change conversation behaviours in both the person with PPA and their communication partner (CP). CPT has a growing evidence base in stroke aphasia; however, these programmes are not designed to meet the needs of people with progressive communication difficulties. To address this, the authors developed a CPT program entitled Better Conversations with PPA (BCPPA) and undertook a pilot trial to establish for a future full trial; predicted recruitment rates, acceptability, an assessment of treatment fidelity and an appropriate primary outcome measure. METHODOLOGY: This was a single-blind, randomised controlled pilot study comparing BCPPA to no treatment, delivered across 11 National Health Service Trusts in the UK. A random sample of eight recordings of local collaborators delivering the intervention were analysed to examine fidelity. Participants completed feedback forms reporting on acceptability. Pre- and post-intervention measures targeted conversation behaviours, communication goals and quality of life. RESULTS: Eighteen people with PPA and their CPs (9 randomised to BCPPA, 9 randomised to no treatment) completed the study. Participants in the intervention group rated BCPPA positively. Treatment fidelity was 87.2%. Twenty-nine of 30 intervention goals were achieved or over-achieved and 16 of 30 coded conversation behaviours demonstrated change in the intended direction. The Aphasia Impact Questionnaire was identified as the preferred outcome measure. CONCLUSION: The first randomised controlled UK pilot study of a CPT program for people with PPA and their families demonstrates BCPPA is a promising intervention. The intervention was acceptable, treatment fidelity high and an appropriate measure identified. Results of this study indicate a future RCT of BCPPA is feasible. TRIAL REGISTRATION: Registered 28/02/2018 ISRCTN10148247

A systematic review of viewing conditions and monitor specifications in mammography

Objectives The purpose of this systematic review was to establish the current status of recommended monitor specifications and viewing conditions in mammography for image acquisition and reporting rooms. A literature search was completed between August 2018 and March 2019 using ScienceDirect, PubMed, Web of Science and MEDLINE databases. An additional manual search was performed to identify relevant guidelines to support the review. Only articles and guidelines written in English were included. Key findings Results were selected according to the following criteria; articles detailing (i) monitor specification and, (ii) viewing conditions in mammography acquisition and reporting rooms. Twenty-one studies met the inclusion criteria. Six papers described monitor specifications, five described viewing conditions and ten guideline documents were identified from the UK, Europe and the US. Common outcomes were that monitors with 3 or 5 MP resolution seemed to be preferred and at the same time higher illumination levels (>15 lux) were found to decrease the luminance of the monitors and negatively impact the assessment of image quality. Contrary to this, the majority of guideline documents recommended illumination levels above 20 Lux. Finally, there is a lack of guidance for viewing conditions in acquisition rooms. Conclusion This review did not reveal any strong evidence for the proposed room illumination levels in acquisition rooms. In reference to monitors specifications, there is preference for using higher resolution displays (3 and 5 MP) but again, the evidence is not strong. Moreover, variance exists in the guidelines and that promotes inconsistency in mammography departments. Implications for practice This review highlights the lack of standardised guidelines and the need for further research on the viewing conditions and monitor specifications for the acquisition rooms in mammography

Survey of monitor specification and viewing conditions in breast screening units in the North West of England

Introduction: Monitor specification and viewing conditions are important factors affecting image assessment in mammography. This survey evaluates the different viewing conditions and monitor specifications that exist in acquisition and reporting rooms in UK breast screening units. Methods: Static (n=10) and mobile (n=2) breast screening units were evaluated in North West England. Room illumination levels were measured in 3 locations for each room using a calibrated Lux meter and the specification of 122 monitors recorded. Room layout, wall colour, location and number of doors, windows and light sources were recorded. Results: In reporting rooms, 90/91 of monitors had similar technical specifications and were compliant to guidelines. The ambient light levels ranged from 10-25.8 lux. The mean illuminance was 12.32 ± 4.6 lux. In acquisition rooms, great variances appeared in monitor specification and ambient light levels. The majority of monitors (24/34) had 3 megapixel (MB) optimum resolution but the ambient light level ranged from 10-1020 lux. The mean illuminance was 105.3 ± 178.8 lux. The mobile units were consistent with each other and compliant with guidelines. Conclusion: A lack of consistency and great variances appeared in terms of ambient light levels and monitor specifications in the image acquisition rooms. However, there was excellent consistency among the illumination measurements and the monitors’ technical specifications in the reporting rooms. Implications for practice: This research demonstrates, for the first time, the need for further research and specialised guidelines for acquisition rooms

Can shoulder range of movement be measured accurately using the Microsoft Kinect sensor plus Medical Interactive Recovery Assistant (MIRA) software?

BackgroundThis study compared the accuracy of measuring shoulder range of movement (ROM) with a simple laptop-sensor combination vs. trained observers (shoulder physiotherapists and shoulder surgeons) using motion capture (MoCap) laboratory equipment as the gold standard. MethodsThe Microsoft Kinect sensor (Microsoft Corp., Redmond, WA, USA) tracks 3-dimensional human motion. Ordinarily used with an Xbox (Microsoft Corp.) video game console, Medical Interactive Recovery Assistant (MIRA) software (MIRA Rehab Ltd., London, UK) allows this small sensor to measure shoulder movement with a standard computer. Shoulder movements of 49 healthy volunteers were simultaneously measured by trained observers, MoCap, and the MIRA device. Internal rotation was assessed with the shoulder abducted 90° and external rotation with the shoulder adducted. Visual estimation and MIRA measurements were compared with gold standard MoCap measurements for agreement using Bland-Altman methods. Results There were 1670 measurements analyzed. The MIRA evaluations of all 4 cardinal shoulder movements were significantly more precise, with narrower limits of agreement, than the measurements of trained observers. MIRA achieved ±11° (95% confidence interval [CI], 8.7°-12.6°) for forward flexion vs. ±16° (95% CI, 14.6°-17.6°) by trained observers. For abduction, MIRA showed ±11° (95% CI, 8.7°-12.8°) against ±15° (95% CI, 13.4°-16.2°) for trained observers. MIRA attained ±10° (95% CI, 8.1°-11.9°) during external rotation measurement, whereas trained observers only reached ±21° (95% CI, 18.7°-22.6°). For internal rotation, MIRA achieved ±9° (95% CI, 7.2°-10.4°), which was again better than TOs at ±18° (95% CI, 16.0°-19.3°). ConclusionsA laptop combined with a Microsoft Kinect sensor and the MIRA software can measure shoulder movements with acceptable levels of accuracy. This technology, which can be easily set up, may also allow precise shoulder ROM measurement outside the clinic setting

Can the anode heel effect be used to optimise radiation dose and image quality for AP pelvis radiography?

Introduction: A study was conducted to determine whether the anode heel effect can be used to influence optimisation of radiation dose and image quality (IQ) for AP pelvis radiography. Methods: ATOM dosimetry phantom and an anthropomorphic phantom were positioned for AP pelvis. Using a CR system, images were acquired and doses were measured with phantom feet toward anode and then feet toward cathode. Exposure factors (kVp, mAs and SID) were systematically generated using a factorial design. Images were scored visually for quality using relative visual grading together with a 3 point Likert scale. Signal to noise ratio was also calculated as a physical measure of image quality. Dosimetry data were collected for the ovaries and testes. Results: The optimum technique for male, which resulted in lower dose and suitable image quality, was with feet positioned toward the anode (0.80±0.03 mGy; SNR of 38±2.9; visual IQ score 3.13± 0.35). The optimum technique for female was with feet toward anode (0.23±0.02 mGy; SNR of 34.7±2.6; visual IQ score 3.15± 0.26). kVp had the biggest effect on both visual and physical image quality metrics (p˂0.001) for both tube orientations, whereas SID had the lowest effect on both visual and physical image quality metrics compared with mAs and kVp (p˂0.001). The effect of SID on the SNR was not significant (p>0.05) with feet toward anode. Conclusion: Positioning the patient with feet toward the anode, as opposed to the cathode, has no adverse effect on visual image quality assessment but it does have an effect on physical image quality. Implications for Practice:This study would add a new clinical concept in positioning of AP pelvis radiography especially for male positioning

S-COL: A Copernican turn for the development of flexibly reusable collaboration scripts

Collaboration scripts are usually implemented as parts of a particular collaborative-learning platform. Therefore, scripts of demonstrated effectiveness are hardly used with learning platforms at other sites, and replication studies are rare. The approach of a platform-independent description language for scripts that allows for easy implementation of the same script on different platforms has not succeeded yet in making the transfer of scripts feasible. We present an alternative solution that treats the problem as a special case of providing support on top of diverse Web pages: In this case, the challenge is to trigger support based on the recognition of a Web page as belonging to a specific type of functionally equivalent pages such as the search query form or the results page of a search engine. The solution suggested has been implemented by means of a tool called S-COL (Scripting for Collaborative Online Learning) and allows for the sustainable development of scripts and scaffolds that can be used with a broad variety of content and platforms. The tool’s functions are described. In order to demonstrate the feasibility and ease of script reuse with S-COL, we describe the flexible re-implementation of a collaboration script for argumentation in S-COL and its adaptation to different learning platforms. To demonstrate that a collaboration script implemented in S-COL can actually foster learning, an empirical study about the effects of a specific script for collaborative online search on learning activities is presented. The further potentials and the limitations of the S-COL approach are discussed

Identification of novel macrolides with antibacterial, anti-inflammatory and type I and III IFN-augmenting activity in airway epithelium

BACKGROUND: Exacerbations of asthma and COPD are triggered by rhinoviruses. Uncontrolled inflammatory pathways, pathogenic bacterial burden and impaired antiviral immunity are thought to be important factors in disease severity and duration. Macrolides including azithromycin are often used to treat the above diseases, but exhibit variable levels of efficacy. Inhaled corticosteroids are also readily used in treatment, but may lack specificity. Ideally, new treatment alternatives should suppress unwanted inflammation, but spare beneficial antiviral immunity. METHODS: In the present study, we screened 225 novel macrolides and tested them for enhanced antiviral activity against rhinovirus, as well as anti-inflammatory activity and activity against Gram-positive and Gram-negative bacteria. Primary bronchial epithelial cells were grown from 10 asthmatic individuals and the effects of macrolides on rhinovirus replication were also examined. Another 30 structurally similar macrolides were also examined. RESULTS: The oleandomycin derivative Mac5, compared with azithromycin, showed superior induction (up to 5-fold, EC50 = 5-11 μM) of rhinovirus-induced type I IFNβ, type III IFNλ1 and type III IFNλ2/3 mRNA and the IFN-stimulated genes viperin and MxA, yet had no effect on IL-6 and IL-8 mRNA. Mac5 also suppressed rhinovirus replication at 48 h, proving antiviral activity. Mac5 showed antibacterial activity against Gram-positive Streptococcus pneumoniae; however, it did not have any antibacterial properties compared with azithromycin when used against Gram-negative Escherichia coli (as a model organism) and also the respiratory pathogens Pseudomonas aeruginosa and non-typeable Haemophilus influenzae. Further non-toxic Mac5 derivatives were identified with various anti-inflammatory, antiviral and antibacterial activities. CONCLUSIONS: The data support the idea that macrolides have antiviral properties through a mechanism that is yet to be ascertained. We also provide evidence that macrolides can be developed with anti-inflammatory, antibacterial and antiviral activity and show surprising versatility depending on the clinical need

Benznidazole biotransformation and multiple targets in <i>Trypanosoma</i> cruzi revealed by metabolomics

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; The first line treatment for Chagas disease, a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi, involves administration of benznidazole (Bzn). Bzn is a 2-nitroimidazole pro-drug which requires nitroreduction to become active, although its mode of action is not fully understood. In the present work we used a non-targeted MS-based metabolomics approach to study the metabolic response of T. cruzi to Bzn.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methodology/Principal findings&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Parasites treated with Bzn were minimally altered compared to untreated trypanosomes, although the redox active thiols trypanothione, homotrypanothione and cysteine were significantly diminished in abundance post-treatment. In addition, multiple Bzn-derived metabolites were detected after treatment. These metabolites included reduction products, fragments and covalent adducts of reduced Bzn linked to each of the major low molecular weight thiols: trypanothione, glutathione, γ-glutamylcysteine, glutathionylspermidine, cysteine and ovothiol A. Bzn products known to be generated in vitro by the unusual trypanosomal nitroreductase, TcNTRI, were found within the parasites, but low molecular weight adducts of glyoxal, a proposed toxic end-product of NTRI Bzn metabolism, were not detected.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions/significance&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Our data is indicative of a major role of the thiol binding capacity of Bzn reduction products in the mechanism of Bzn toxicity against T. cruzi