Supporting people-centred design through information and empathy

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.People-centred design is a design approach that takes the intended end users into consideration throughout the development process, resulting in more appropriate design output in terms of meeting peoples needs and wants. There is recognised value in the use of user-based information, and in establishing empathy with those being designed for, yet there is a distinct lack of literature addressing both aspects and the potential for associated support mechanisms for designers. The combination of information and empathy is the focus of this research. This thesis presents studies carried out to investigate the potential for ‘supporting people-centred design through information and empathy’, focusing upon the early stages of design development. The main aims of this research were to understand designers’ processes and where users fit into these, and to suggest means of support that could promote user focus whilst remaining a practical and appropriate complement to established methods. The under-explored nature of this area required empirical research engaging in practical ways with designers, which was achieved through in-depth probe studies and follow-up interviews with 10 designers; active participation in two four-month real-life design projects; the examination and co-creation of resource tool concepts during two workshops, each with 20 design participants; and ‘MHIRROR’ (Means of Human Information Retrieval, Representation, Organisation and Reflection), a mixed media human information resource was developed and trialed with six experienced inclusive design practitioners. These qualitative explorations with designers and within real-life projects facilitated understanding of the potential for human information resources to support the design process. The thesis has made original contribution to knowledge in terms of the formation of a framework for the manipulation and integration of human information into the design process; the iterative design and embodiment of a working prototype resource MHIRROR, and it has provided insights into the value of information and empathy resource combinations and their potential to promote people-centred design.This study is funded by the Engineering and Physical Sciences Research Council (EPSRC)

Clinical observation during alemtuzumab administration

• Alemtuzumab has been associated with stroke and cervicocephalic dissections. • Monitoring blood pressure is currently recommended by the EMA. • Monitoring blood pressure is not useful in predicting these rare side effects

Virtual Interviewing for Residency/Fellowship during the COVID-19 Pandemic

Virtual interviewing for graduate medical education (GME) had been experimented with on a small scale in the late 2000s and early 2010s, but it became a necessity for the 2020–2021 match season as a result of the COVID-19 pandemic. We will briefly discuss the history of virtual interviewing and the published literature on virtual interviewing in GME. Based on the literature and recommendations from various organizations, we address preparation for virtual interviews including special considerations for programs and fellowships. We discuss the pros and cons of virtual interviewing both in order to better understand the current situation and to make informed choices moving forward regarding continuation of virtual interviewing versus returning to in-person interviewing

Reliability of functional and predictive methods to estimate the hip joint centre in human motion analysis in healthy adults.

In human motion analysis predictive or functional methods are used to estimate the location of the hip joint centre (HJC). It has been shown that the Harrington regression equations (HRE) and geometric sphere fit (GSF) method are the most accurate predictive and functional methods, respectively. To date, the comparative reliability of both approaches has not been assessed. The aims of this study were to (1) compare the reliability of the HRE and the GSF methods, (2) analyse the impact of the number of thigh markers used in the GSF method on the reliability, (3) evaluate how alterations to the movements that comprise the functional trials impact HJC estimations using the GSF method, and (4) assess the influence of the initial guess in the GSF method on the HJC estimation. Fourteen healthy adults were tested on two occasions using a three-dimensional motion capturing system. Skin surface marker positions were acquired while participants performed quite stance, perturbed and non-perturbed functional trials, and walking trials. Results showed that the HRE were more reliable in locating the HJC than the GSF method. However, comparison of inter-session hip kinematics during gait did not show any significant difference between the approaches. Different initial guesses in the GSF method did not result in significant differences in the final HJC location. The GSF method was sensitive to the functional trial performance and therefore it is important to standardize the functional trial performance to ensure a repeatable estimate of the HJC when using the GSF method

A theory of how active behavior stabilises neural activity: neural gain modulation by closed-loop environmental feedback

During active behaviours like running, swimming, whisking or sniffing, motor actions shape sensory input and sensory percepts guide future motor commands. Ongoing cycles of sensory and motor processing constitute a closed-loop feedback system which is central to motor control and, it has been argued, for perceptual processes. This closed-loop feedback is mediated by brainwide neural circuits but how the presence of feedback signals impacts on the dynamics and function of neurons is not well understood. Here we present a simple theory suggesting that closed-loop feedback between the brain/body/environment can modulate neural gain and, consequently, change endogenous neural fluctuations and responses to sensory input. We support this theory with modeling and data analysis in two vertebrate systems. First, in a model of rodent whisking we show that negative feedback mediated by whisking vibrissa can suppress coherent neural fluctuations and neural responses to sensory input in the barrel cortex. We argue this suppression provides an appealing account of a brain state transition (a marked change in global brain activity) coincident with the onset of whisking in rodents. Moreover, this mechanism suggests a novel signal detection mechanism that selectively accentuates active, rather than passive, whisker touch signals. This mechanism is consistent with a predictive coding strategy that is sensitive to the consequences of motor actions rather than the difference between the predicted and actual sensory input. We further support the theory by re-analysing previously published two-photon data recorded in zebrafish larvae performing closed-loop optomotor behaviour in a virtual swim simulator. We show, as predicted by this theory, that the degree to which each cell contributes in linking sensory and motor signals well explains how much its neural fluctuations are suppressed by closed-loop optomotor behaviour. More generally we argue that our results demonstrate the dependence of neural fluctuations, across the brain, on closed-loop brain/body/environment interactions strongly supporting the idea that brain function cannot be fully understood through open-loop approaches alone

Relative adrenal insufficiency in mice deficient in 5α-reductase 1

Patients with critical illness or hepatic failure exhibit impaired cortisol responses to ACTH, a phenomenon known as ‘relative adrenal insufficiency’. A putative mechanism is that elevated bile acids inhibit inactivation of cortisol in liver by 5α-reductases type 1 and type 2 and 5β-reductase, resulting in compensatory downregulation of the hypothalamic–pituitary–adrenal axis and adrenocortical atrophy. To test the hypothesis that impaired glucocorticoid clearance can cause relative adrenal insufficiency, we investigated the consequences of 5α-reductase type 1 deficiency in mice. In adrenalectomised male mice with targeted disruption of 5α-reductase type 1, clearance of corticosterone was lower after acute or chronic (eightfold, P<0.05) administration, compared with WT control mice. In intact 5α-reductase-deficient male mice, although resting plasma corticosterone levels were maintained, corticosterone responses were impaired after ACTH administration (26% lower, P<0.05), handling stress (2.5-fold lower, P<0.05) and restraint stress (43% lower, P<0.05) compared with WT mice. mRNA levels of Nr3c1 (glucocorticoid receptor), Crh and Avp in pituitary or hypothalamus were altered, consistent with enhanced negative feedback. These findings confirm that impaired peripheral clearance of glucocorticoids can cause ‘relative adrenal insufficiency’ in mice, an observation with important implications for patients with critical illness or hepatic failure, and for patients receiving 5α-reductase inhibitors for prostatic disease

Post-COVID-19 illness trajectory: a multisystem investigation [Pre-print]

Background: The pathophysiology and trajectory of multiorgan involvement in post-COVID-19 syndrome is uncertain. Methods: A prospective, multicenter, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated 28-60 days post-discharge (visit 2). Multisystem investigations included chest computed tomography with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, digital electrocardiography, and multisystem biomarkers. The primary outcome was the adjudicated likelihood of myocarditis. Results: 161 patients (mean age 55 years, 43% female) and 27 controls with similar age, sex, ethnicity, and vascular risk factors were enrolled from 22 May 2020 to 2 July 2021 and had a primary outcome evaluation. Compared to controls, at 28-60 days post-discharge, patients with COVID-19 had persisting evidence of cardio-renal involvement, systemic inflammation, and hemostasis pathway activation. Myocarditis was adjudicated as being not likely (n=17; 10%), unlikely (n=56; 35%), probable (n=67; 42%) or very likely (n=21; 13%). Acute kidney injury (odds ratio, 95% confidence interval: 3.40 (1.13, 11.84); p=0.038) and low hemoglobin A1c (0.26 (0.07, 0.87); p=0.035) were multivariable associates of adjudicated myocarditis. During convalescence, compared to controls, COVID-19 was associated with worse health-related quality of life (EQ5D-5L) (p&lt;0.001), illness perception (p&lt;0.001), anxiety and depression (p&lt;0.001), physical activity (p&lt;0.001) and predicted maximal oxygen utilization (ml/kg/min) (p&lt;0.001). These measures were associated with adjudicated myocarditis. Conclusions: The illness trajectory of COVID-19 includes persisting cardio-renal inflammation, lung damage and hemostasis activation. Adjudicated myocarditis occurred in one in eight hospitalized patients and was associated with impairments in health status, physical and psychological wellbeing during community convalescence. Public registration: ClinicalTrials.gov identifier is NCT04403607