Cognitive behaviour therapy plus aerobic exercise training to increase activity in patients with myotonic dystrophy type 1 (DM1) compared to usual care (OPTIMISTIC):Study protocol for randomised controlled trial

Peer reviewedPublisher PD

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Review of the economic benefits of training and qualifications, as shown by research based on cross sectional and administrative data

Report that provides evidence on employment and earnings benefits from vocational qualifications. This includes: - the wage and employment benefits which learners gain from different qualifications - the value of qualifications held in the working age population and how far returns might vary for different individuals and in different circumstances The report reviewed recent research that took different approaches. These approaches: - used new matched data which matches learner information with their employment and earnings data from HM Revenue & Customs (HMRC) and their benefit claims from the Department for Work & Pensions (DWP) - applied different well-established techniques to recent labour force survey data It concludes that the two approaches answer slightly different questions about the benefits of vocational training, and government should continue to use both. The matched data, because of its large sample size, has great potential to become the main source of future work. However we need to understand some issues with the data before this can happen

Measuring additionality in apprenticeships

This report follows the research paper on Assessing Public Investment in Education and Skills. It considers how best to estimate the value added by government investment in apprenticeships: - to what extent does the government pay for training which employers would have paid for themselves? - how much apprenticeship and other work-based training would take place without public funding? It looks at how we can use existing datasets to improve our understanding of this issue, especially surveys which have become available since the earlier research paper. It also recommends what further data can be collected and analysed in a cost-effective way

Kinematic analyses of seated throwing activities with and without an assistive pole

In Paralympic seated throwing events, the athlete can throw with and without an assistive pole. This study aimed to identify and compare performance-related kinematic variables associated with both seated throwing techniques. Twenty-nine non-disabled males (21.9 ± 2.6 years) performed 12 maximal throws using a 1-kg ball in two conditions (no-pole and pole). Automatic 3D-kinematic tracking (150 Hz) and temporal data were acquired. There was no significant difference between ball speeds at the point of release between conditions (no-pole = 12.8 ± 1.6 m/s vs. pole = 12.9 ± 1.5 m/s). There were four kinematic variables that were strongly correlated with ball speed when throwing with or without an assistive pole. These variables were elbow flexion at the start phase (pole r = .39 and no-pole r = .41), maximum shoulder external rotation angular velocity during the arm cocking phase (pole r = .42), maximum shoulder internal rotation angular velocity during the arm acceleration phase (pole r = .47), and should internal rotation angular velocity at the instant of ball release (pole r = .40). The pole clearly influenced the throwing technique with all four strongly correlated variables identified in this condition, compared to only one during the no-pole condition. When using the pole, participants produced significantly higher shoulder internal rotation angular velocities during the arm acceleration phase (pole = 367 ± 183°/s vs. no-pole = 275 ± 178°/s, p < .05) and at the instant of ball release (pole = 355 ± 115°/s vs. no-pole = 264 ± 120°/s, p < .05), compared to throwing without the pole. These findings have implications for the development of evidence-based classification systems in Paralympic seated throwing, and facilitate research that investigates the impact of impairment on seated throwing performance