Does a Screening Trial for Spinal Cord Stimulation in Patients with Chronic Pain of Neuropathic Origin have Clinical Utility and Cost-Effectiveness? (TRIAL-STIM Study): study protocol for a randomised controlled trial

Abstract Background The TRIAL-STIM Study aims to assess the diagnostic performance, clinical outcomes and cost-effectiveness of a screening trial prior to full implantation of a spinal cord stimulation (SCS) device. Methods/design The TRIAL-STIM Study is a superiority, parallel-group, three-centre, randomised controlled trial in patients with chronic neuropathic pain with a nested qualitative study and economic evaluation. The study will take place in three UK centres: South Tees Hospitals NHS Foundation Trust (The James Cook University Hospital); Basildon and Thurrock University Hospitals NHS Foundation Trust; and Leeds Teaching Hospitals NHS Trust. A total of 100 adults undergoing SCS implantation for the treatment of neuropathy will be included. Subjects will be recruited from the outpatient clinics of the three participating sites and randomised to undergo a screening trial prior to SCS implant or an implantation-only strategy in a 1:1 ratio. Allocation will be stratified by centre and minimised on patient age (≥ 65 or < 65 years), gender, presence of failed back surgery syndrome (or not) and use of high frequency (HF10™) (or not). The primary outcome measure is the numerical rating scale (NRS) at 6 months compared between the screening trial and implantation strategy and the implantation-only strategy. Secondary outcome measures will include diagnostic accuracy, the proportion of patients achieving at least 50% and 30% pain relief at 6 months as measured on the NRS, health-related quality-of-life (EQ-5D), function (Oswestry Disability Index), patient satisfaction (Patients’ Global Impression of Change) and complication rates. A nested qualitative study will be carried out in parallel for a total of 30 of the patients recruited in each centre (10 at each centre) to explore their views of the screening trial, implantation and overall use of the SCS device. The economic evaluation will take the form of a cost–utility analysis. Discussion The TRIAL-STIM Study is a randomised controlled trial with a nested qualitative study and economic evaluation aiming to determine the clinical utility of screening trials of SCS as well as their cost-effectiveness. The nested qualitative study will seek to explore the patient’s view of the screening trials, implantation and overall use of SCS. Trial registration ISRCTN, ISRCTN60778781. Registered on 15 August 2017

Applying design for production methods for improved product development

Design for production (DFP) refers to methods that evaluate manufacturing system performance as a function of product design variables. DFP can lead a product development team to consider changing the product design to avoid problems or improve profitability. In addition, DFP can provoke suggestions to improve the manufacturing system. This paper reviews studies that have successfully applied DFP techniques in a variety of product domains. In addition, the paper discusses how product development teams can create new DFP techniques that will help them create more profitable products. The presentation of these examples and guidelines should encourage the use of DFP and improve product development

Optimal Exploitation of Native Arbuscular and Vesicular-Arbuscular Mycorrhizae for Improving the Yield of Banana through IPNM

280-285The R&D banana orchard of the North Maharashtra University harboured diversified species of vesicular-arbuscular mycorrhizal (VAM) fungi belonging to the genera Glomus, Gigaspora, Sclerocystis and Scutellospora. These fungi infected the roots severely (78.3%) and showed elevated (68.7 g-1 soil) spore density in the mycorrhizosphere of plants for integrated plant nutrition management (IPNM) system as compared to chemical fertilizers alone (traditional farming; 49.2% & 39.3 g-1 soil). This resulted in retardation of the establishment of nematodes in root zone of IPNM treatment (2.1 g-1 soil) as compared to chemical treatment (5.5 g-1 soil). VAM fungi enabled proper nourishment and protection of crop in IPNM treatment as compared to traditional way, which was evident from (a) reduced plant mortality (12%) of planted sword suckers, (b) enhanced greenery (foliar chlorophyll 778 μg g-1), (c) improved nutrient uptake on dry weight basis (3.62% N; 0.31 % P; & 6.45% K), (d) elevated finger number (137.6 per bunch) size (length 21.6 cm & girth 12.4 cm) and weight (130.8 g), and (e) overall vigour and robustness. Hence, exploitation of V AM through adoption of IPNM system revealed the (i) relatively increased banana productivity (76.5%,72 tonnes ha-1) and recyclable biowaste (36.6 kg), (ii) saving of 50% chemical fertilizers, and (iii) permitted control over soil fertility in farmer's favour over traditional cultivation practices. These findings related to native VAM fungi in IPNM, traditional farming and typical soil systems for cultivation of bananas are discussed in detail

Production of microbial iron chelators (siderophores) by fluorescent Pseudomonads

484-490Two fluorescent pseudomonads, Pseudomonas fluorescens NCIM 5096 and P. putida NCIM 2847 produced maximum yield of hydroxamate type of siderophore (87 & 83% units, respectively) in modified succinic acid medium (SM). (NH4)2SO4 and amino acids were found to stimulate bacterial growth as well as siderophore production. However, optimum siderophore yield was obtained with urea. Increase in iron concentration up to 100 µM favoured growth but drastically affected siderophore production in both the strains. Threshold level of iron (FeCl3), which repressed siderophore production in both the strains, was 30 µM. Sunflower oil proved to be suitable and cost effective defoaming agent for siderphore production in bioreactors. The results of shake flask level were found reproducible at scaled up conditions in bioreactors. Moreover, P. fluorescens NCIM 5096 inoculation enhanced seed germination, root length and shoot length of wheat (Triticum aestivum) under pot culture conditions

Embedded

With the advent of new materials and technologies that enable passive components to be embedded within electronic substrates, one key question that arises is: under what circumstances (and for what type of applications) is it economically viable to consider using embedded passives? The economic issues that must be considered consist of a combination of manufacturing costs and throughputs, and non-manufacturing life cycle costs. This paper discusses the assessment of manufacturing costs associated with embedding resistors and capacitors in printed circuit boards and provides cost modeling results for an avionics board. The discussion is extended to include optimizing the specific embedded passive content in a board and design for production modeling when embedded passives are present. Life cycle cost issues are also qualitatively discussed