N<i>e</i>XOS – the design, development and evaluation of a rehabilitation system for the lower limbs

Recent years have seen the development of a number of automated and semi-automated systems to support for physiotherapy and rehabilitation. These deploy a range of technologies from highly complex purpose built systems to approaches based around the use of industrial robots operating either individually or in combination for applications ranging from stroke to mobility enhancement. The NeXOS project set out to investigate an approach to the rehabilitation of the lower limbs in a way which brought together expertise in engineering design and mechatronics with specilists in rehabilitation and physiotherapy. The resulting system has resulted in a prototype of a system which is capable in operating in a number of modes from fully independent to providing direct support to a physiotherapist during manipulation of the limb. Designed around a low cost approach for an implementation ultimately capable of use in a patients home using web-baased strategies for communication with their support team, the prototype NeXOS system has validated the adoption of an integrated approach to its development. The paper considers this design and development process and provides the results from the initial tests with physiotherapists to establish the operational basis for clinical implementation

The interaction between transpolar arcs and cusp spots

Transpolar arcs and cusp spots are both auroral phenomena which occur when the interplanetary magnetic field is northward. Transpolar arcs are associated with magnetic reconnection in the magnetotail, which closes magnetic flux and results in a "wedge" of closed flux which remains trapped, embedded in the magnetotail lobe. The cusp spot is an indicator of lobe reconnection at the high-latitude magnetopause; in its simplest case, lobe reconnection redistributes open flux without resulting in any net change in the open flux content of the magnetosphere. We present observations of the two phenomena interacting--i.e., a transpolar arc intersecting a cusp spot during part of its lifetime. The significance of this observation is that lobe reconnection can have the effect of opening closed magnetotail flux. We argue that such events should not be rare

Visions of value : leading the development of a view of the University Library in the 21st century

Over the course of 2018 the University of Sheffield Library conducted a series of interviews and workshops with stakeholders as part of a strategic project to reflect on the value of the university library in the 21st century. Using a mixed methodology, participants were asked to reflect upon the future Higher Education (HE) environment for the university and, for academic participants, their discipline. In this context participants were also asked to reflect upon the future value of the University Library in a series of questions designed to elicit value statements using a tool which the project group have called the ‘Wheel of Value’. The resulting reflections upon the future environment have been grouped into four categories reflecting the drivers for change; Digitalisation, Student Experience, Diversification and Collaboration recognizing that there is considerable overlap and interconnection between these. The reflections on the future value of the library are presented by Wheel of Value higher order categorization. This approach proved useful in eliciting responses from participants in the face of recognized difficulty in getting beyond current views of the library and the approach is recommended to other universities looking to carry out a similar project. The results of this research will be used to inform the development of a view of the library for the purpose of engaging with our university community and key partners

Process evaluation and exploration of telehealth in motor neuron disease in a UK specialist centre

Objectives To evaluate the processes involved in using a novel digitally enabled healthcare system (telehealth in motor neuron disease (TiM)) in people living with motor neuron disease (MND) and their informal carers. We examined TiM implementation, potential mechanisms of impact and contextual factors that might influence TiM implementation or impact. Design An 18-month, single-centre process evaluation within a randomised, pilot and feasibility study. Intervention TiM plus usual care versus usual care alone. Setting A specialist UK MND care centre. Participants 40 patients with MND and 37 primary informal carers. Primary and secondary outcome measures Patient, carer and staff outcomes and experiences using semistructured interviews. Descriptive data on implementation and use of TiM. Results The TiM was acceptable and accessible to patients, carers and staff. Intervention uptake and adherence were good: 14 (70%) patients completed a TiM session at least fortnightly. Barriers to TiM use (such as technology experience and disability) were overcome with well-designed technology and face-to-face training. Reported potential benefits of TiM included improved communication and care coordination, reassurance, identification of complications and the potential for TiM to be an alternative or addition to clinic. Benefits depended on patients’ current level of needs or disability. The main challenges were the large number of alerts that were generated by TiM, how the clinicians responded to these alerts and the mismatch between patient/carer expectations and nurses actions. This could be improved by better communication systems and adjusting the alerts algorithm. Conclusion TiM has the potential to facilitate access to specialist care, but further iterative developments to the intervention and process evaluations of the TiM in different services are required

Using telehealth in motor neuron disease to increase access to specialist multidisciplinary care : a UK-based pilot and feasibility study

Objectives Care of patients with motor neuron disease (MND) in a specialist, multidisciplinary clinic is associated with improved survival, but access is not universal. We wanted to pilot and establish the feasibility of a definitive trial of a novel telehealth system (Telehealth in Motor neuron disease, TiM) in patients with MND. Design An 18-month, single-centre, mixed-methods, randomised, controlled pilot and feasibility study. Intervention TiM telehealth plus usual care versus usual care. Setting A specialist MND care centre in the UK. Participants Patients with MND and their primary informal carers. Primary and secondary outcome measures Recruitment, retention and data collection rates, clinical outcomes including participant quality of life and anxiety and depression. Results Recruitment achieved the target of 40 patients and 37 carers. Participant characteristics reflected those attending the specialist clinic and included those with severe disability and those with limited experience of technology. Retention and data collection was good. Eighty per cent of patients and 82% of carer participants reported outcome measures were completed at 6 months. Using a longitudinal analysis with repeated measures of quality of life (QoL), a sample size of 131 per arm is recommended in a definitive trial. The methods and intervention were acceptable to participants who were highly motivated to participate to research. The low burden of participation and accessibility of the intervention meant barriers to participation were minimal. However, the study highlighted difficulties assessing the associated costs of the intervention, the challenge of recruitment in such a rare disease and the difficulties of producing rigorous evidence of impact in such a complex intervention. Conclusion A definitive trial of TiM is feasible but challenging. The complexity of the intervention and heterogeneity of the patient population means that a randomised controlled trial may not be the best way to evaluate the further development and implementation of the TiM

ROBO2 is a stroma suppressor gene in the pancreas and acts via TGF-β signalling.

Whereas genomic aberrations in the SLIT-ROBO pathway are frequent in pancreatic ductal adenocarcinoma (PDAC), their function in the pancreas is unclear. Here we report that in pancreatitis and PDAC mouse models, epithelial Robo2 expression is lost while Robo1 expression becomes most prominent in the stroma. Cell cultures of mice with loss of epithelial Robo2 (Pdx1Cre;Robo2F/F) show increased activation of Robo1+ myofibroblasts and induction of TGF-β and Wnt pathways. During pancreatitis, Pdx1Cre;Robo2F/F mice present enhanced myofibroblast activation, collagen crosslinking, T-cell infiltration and tumorigenic immune markers. The TGF-β inhibitor galunisertib suppresses these effects. In PDAC patients, ROBO2 expression is overall low while ROBO1 is variably expressed in epithelium and high in stroma. ROBO2low;ROBO1high patients present the poorest survival. In conclusion, Robo2 acts non-autonomously as a stroma suppressor gene by restraining myofibroblast activation and T-cell infiltration. ROBO1/2 expression in PDAC patients may guide therapy with TGF-β inhibitors or other stroma /immune modulating agents

The fusion approach – applications for understanding local government and European integration

The article explores the theoretical capabilities of the fusion approach as a conceptual ‘kit’ to explain the ‘bigger picture’ of European integration from a local government perspective. Fusion addresses the rationales and methods facilitating the transfer of policy-making competences to the European level. It understands European integration as a merging of public resources and policy instruments from multiple levels of government, whereby accountability and responsibilities for policy outcomes become blurred. The article argues that the fusion approach is useful to explain the systemic linkages between macro-trajectories and the corresponding change at the local level; the fusion dynamics of the local and European levels in a common policy-cycle; and the attitudes of local actors towards the EU. Although the article concludes that local government is rather modestly ‘fused’ into the EU, fusion approaches allow examining the extent to which the local level has become integrated into the European governance system

BronchUK: protocol for an observational cohort study and biobank in bronchiectasis

Bronchiectasis has been a largely overlooked disease area in respiratory medicine. This is reflected by a shortage of large-scale studies and lack of approved therapies, in turn leading to a variation of treatment across centres. BronchUK (Bronchiectasis Observational Cohort and Biobank UK) is a multicentre, prospective, observational cohort study working collaboratively with the European Multicentre Bronchiectasis Audit and Research Collaboration project. The inclusion criteria for patients entering the study are a clinical history consistent with bronchiectasis and computed tomography demonstrating bronchiectasis. Main exclusion criteria are 1) patients unable to provide informed consent, 2) bronchiectasis due to known cystic fibrosis or where bronchiectasis is not the main or co-dominant respiratory disease, 3) age <18 years, and 4) prior lung transplantation for bronchiectasis. The study is aligned to standard UK National Health Service (NHS) practice with an aim to recruit a minimum of 1500 patients from across at least nine secondary care centres. Patient data collected at baseline includes demographics, aetiology testing, comorbidities, lung function, radiology, treatments, microbiology and quality of life. Patients are followed up annually for a maximum of 5 years and, where able, blood and/or sputa samples are collected and stored in a central biobank. BronchUK aims to collect robust longitudinal data that can be used for analysis into current NHS practice and patient outcomes, and to become an integral resource to better inform future interventional studies in bronchiectasis

Probing the distant universe with a very luminous fast radio burst at redshift 1

Fast radio bursts are millisecond-duration pulses of radio emission that have been found to originate at extragalactic distances. The bursts show dispersion imparted by intervening plasma, with the bulk attributed to the intergalactic medium. Here we report the discovery of a burst, FRB20220610A, in a complex host galaxy system at a redshift of $z=1.016 \pm 0.002$. The relationship between its redshift and dispersion confirm that the bulk of the baryonic matter was ionized and in the intergalactic medium when the universe was almost half its present age. The burst shows evidence for passage through a significant additional column of turbulent and magnetized high-redshift plasma. It extends the maximum observed burst energy by a factor of four, confirming the presence of an energetic burst population at high redshift.Comment: 40 page