PRELIMINARY DEVELOPMENT OF A RECONFIGURABLE GARMENT SYSTEM FOR INTERACTIVE BIOMECHANICS

This paper presents a garment system that uses electronic textile strain sensors attached to a host garment to enable interactive biomechanical monitoring and biofeedback. A conventional compression garment modified to include strategically placed fastening markers and a corresponding e-textile strain sensor were used to monitor knee flexion and extension during AFL kicking. The output of the garment system was compared with that of a Vicon. During repeated subject kicking the garment system displayed stable operation suggesting it was suitable for use in field based skill interventions involving interactive biofeedback

Reversible tongue atrophy in Lambert-Eaton myasthenic syndrome

Peer reviewedPublisher PD

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Controlling the optical properties of Hafnium Dioxide thin films deposited with Electron Cyclotron Resonance Ion Beam Deposition

The effects of reactive and sputtering oxygen partial pressure on the structure, stoichiometry and optical properties of hafnium oxide (HfO2) thin films have been systematically investigated. The electron cyclotron resonance ion beam deposition (ECR-IBD) technique was used to fabricate the films on to JGS-3 fused silica substrates. The amorphous structure of HfO2 films were determined by X-ray Diffraction. Energy-dispersive X-ray Spectroscopy and Rutherford Backscattering Spectrometry were carried out for the composition and stoichiometry analysis, where this suggests the formation of over-stoichiometric films. The data suggests that the O:Hf ratio ranges from 2.4 – 4.45 to 1 for the ECR-IBD fabricated HfO2 films in this study. The transmission and reflectance spectra of the HfO2 films were measured over a wide range of wavelengths (λ = 185 – 3000 nm) by utilizing a spectrophotometer. The measured spectra were analyzed by an optical fitting software, which utilizes the model modified by O'Leary, Johnson and Lim, to extract the optical properties, refractive index (n) and the bandgap energy (E0). By varying the reactive and sputtering oxygen partial pressure, the optical properties were found to be n = 1.70 – 1.91, and E0 = 5.6 – 6.0 eV. This study provides a flexible method for tuning the optical properties of HfO2 coatings by controlling the mixture of reactive and sputtering gas

Controlling the optical properties of hafnium dioxide thin films deposited with electron cyclotron resonance ion beam deposition

The effects of reactive and sputtering oxygen partial pressure on the structure, stoichiometry and optical properties of hafnium oxide (HfO2) thin films have been systematically investigated. The electron cyclotron resonance ion beam deposition (ECR-IBD) technique was used to fabricate the films on to JGS-3 fused silica substrates. The amorphous structure of HfO2 films were determined by X-ray Diffraction. Energy-dispersive X-ray Spectroscopy and Rutherford Backscattering Spectrometry were carried out for the composition and stoichiometry analysis, where this suggests the formation of over-stoichiometric films. The data suggests that the O:Hf ratio ranges from 2.4 – 4.45 to 1 for the ECR-IBD fabricated HfO2 films in this study. The transmission and reflectance spectra of the HfO2 films were measured over a wide range of wavelengths (λ = 185 – 3000 nm) by utilizing a spectrophotometer. The measured spectra were analyzed by an optical fitting software, which utilizes the model modified by O'Leary, Johnson and Lim, to extract the optical properties, refractive index (n) and the bandgap energy (E0). By varying the reactive and sputtering oxygen partial pressure, the optical properties were found to be n = 1.70 – 1.91, and E0 = 5.6 – 6.0 eV. This study provides a flexible method for tuning the optical properties of HfO2 coatings by controlling the mixture of reactive and sputtering gas

The Future of Cancer and Collective Intelligence in the Post-Covid World

The Future of Cancer and Collective Intelligence in the Post-Covid World project was jointly conceived by the Innovation School at Glasgow School of Art and the Institute of Cancer Sciences at the University of Glasgow. Graduating year Product Design students from the Innovation School were presented with a challenge-based project to produce a vision of the future based on current trends that relate to the Future of Cancer and Collective Intelligence in the Post-Covid World. Currently, cancer research and development occur in isolated pockets within stages across the cancer care continuum, which often negatively impacts on the potential for cancer professionals to exchange, integrate and share data, insights and knowledge across the framework. One of the most significant societal shifts currently taking place within Cancer and Collective Intelligence is the transformation from the siloed clinic point of care model to a seamless continuum of care with greater focus on prevention and early intervention, changing what it means to be someone living with cancer and a professional working within this context. From this new dynamic, emerges the concept of living-labs; transdisciplinary communities of practice involving people working within and living with cancer, capable, through collective intelligence-enabled systems and services, of generating knowledge which can be used locally, and shared globally, to deliver focused innovations across the whole cancer ecosystem. If collective intelligence holds the potential to truly connect people to people, and people to data, across diverse communities, linking peoples’ lived experiences locally and globally, what kinds of new health and care services might emerge to improve cancer control across the continuum from prevention, detection, treatment and survivorship, and what types of new roles might emerge for citizens, patients and community groups to collaboratively drive these forward with health professionals? In order to address this challenge, the GSA Innovation School’s final year Product Design students and faculty formed a dynamic community of practice with cancer practitioners and researchers from the Institute of Cancer Sciences at The University of Glasgow and beyond to envisage a 2030 cancer blueprint as a series of future world exhibits, and create the designed products, services and experiences for the people who might live and work within this ecosystem. This project involved the students working in partnership with an Expert Faculty composed of Cancer Physicians, Cancer Researchers, Social Scientists, Biomedical Engineers, Health Research Specialists, Past Patients, Digital Health Specialists, Design Experts and Government Agencies. The Expert Faculty was assembled from a range of local to global organisations including the University of Glasgow, the Beatson West of Scotland Cancer Centre, the Malawi Ministry of Health and the International Agency for Research on Cancer (IARC is part of the World Health Organization). This project asked the students to embark on a speculative design exploration into future experiences of working and living with cancer ten years from now, where advances in collective intelligence have evolved to the extent that new forms and ecosystems of medical practice, cancer care and experiences of living with, through and beyond cancer transform how we interact with each other, with health professionals and the communities around us. This project was conceived and carried out during the global COVID-19 pandemic. Throughout the project the students positively used this situation to creatively embrace a digital studio practice and innovate around digital and remote access platforms and forums for collaboration, development and engagement. Thus, the designed products, services and experiences for the people who might live and work within the cancer ecosystem are presented as innovative, highly creative, fully immersive, experiential exhibits. The project was divided into two sections: The first was a collaborative stage based on Future Worlds. The worlds are groups of students working together on specific topics, to establish the context for their project and collaborate on research and development. These were clustered together around ‘Future Working’ and ‘Future Living’ but also joined up across these groups to create pairs of worlds, and in the process generate collective intelligence between the groups. The worlds clustered around ‘Future Working’ are Education, Care and Treatment, Prevention and Detection. Future Worlds clustered around ‘Future Living’ are Personal Wellbeing, Communicating Cancer, Beyond Cancer. The second stage saw students explore their individual response to their assigned Future World that had been created in the first stage. Each student developed their own research by iteratively creating a design outcome that was appropriate to the Future cancer World. This culminated in each student producing designed products, services or systems and a communication of the future experiences created. Throughout the project, the results were presented as a series live interactive digitally curated, virtual work-in-progress exhibitions for specific audiences including a special global event to participate in World Cancer Day on the 4th February 2021. An event which allowed the students to actively interact and discuss the project with a global audience of cancer community leaders. The deposited materials are arranged as follows: 1. Readme files - two readme files relate to tage one and stage two of the project as outlined above. 2. Project overview document - gives a visual overview of the structure and timeline of the project. 3. Stage one data folders - the data folders for stage one of the project are named by the six Future Worlds through which each group explored possible futures. 4. Stage two data folders - the data folders for stage two of the project are named for the individual students who conducted the work and organised by the Future World cluster they worked within