Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials

Objective: Impairment of mental well-being (anxiety, depression, stress) is common among people with multiple sclerosis (PwMS). Treatment options are limited, particularly for anxiety. The aim of this study was to update our previous systematic review (2014) and evaluate via meta-analysis the efficacy of mindfulness-based interventions (MBIs) for improving mental well-being in PwMS. Methods: Systematic searches for eligible randomised controlled trials (RCTs) were carried out in seven major databases (November 2017, July 2018), using medical subject headings and key words. Studies were screened, data extracted, quality appraised and analysed by two independent reviewers, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Mental well-being was the primary outcome. Random effects model meta-analysis was performed, with effect size reported as standardised mean difference (SMD). Results: Twelve RCTs including 744 PwMS were eligible for inclusion in the systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6–9 weeks, delivered individually and via groups, both in person and online. Overall SMD for mental well-being (eight studies) was 0.40 (0.28–0.53), p<0.01, I2=28%; against active comparators only (three studies) SMD was 0.17 (0.01–0.32), p<0.05, I2 =0%. Only three adverse events were reported. Conclusions: MBIs are effective at improving mental well-being in PwMS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness

Monitoring and Analysis of Frozen Debris Lobes, Phase I

INE/AUTC 12.2

Design of a slender tuned ultrasonic needle for bone penetration

This paper reports on an ultrasonic bone biopsy needle, particularly focusing on design guidelines applicable for any slender tuned ultrasonic device component. Ultrasonic surgical devices are routinely used to cut a range of biological tissues, such as bone. However the realisation of an ultrasonic bone biopsy needle is particularly challenging. This is due to the requirement to generate sufficient vibrational amplitude capable of penetrating mineralised tissue, while avoiding flexural vibrational responses, which are known to reduce the performance and reliability of slender ultrasonic devices. This investigation uses finite element analysis (FEA) to predict the vibrational behaviour of a resonant needle which has dimensions that match closely to an 8Gx4inch bone marrow biopsy needle. Features of the needle, including changes in material and repeated changes in diameter, have been included and systematically altered to demonstrate that the location of and geometry of these features can significantly affect the resonant frequency of bending and torsional modes of vibration while having a limited effect on the frequency and shape of the tuned longitudinal mode. Experimental modal analysis was used to identify the modal parameters of the selected needle design, validating the FEA model predictions of the longitudinal mode and the close flexural modes. This verifies that modal coupling can be avoided by judicious small geometry modifications. Finally, the tuned needle assembly was driven under typical operational excitation conditions to demonstrate that an ultrasonic biopsy needle can be designed to operate in a purely longitudinal motion

Ultrasonic needles for bone biopsy

Bone biopsy is an invasive clinical procedure where a bone sample is recovered for analysis during the diagnosis of a medical condition. When the architecture of the bone tissue is required to be preserved, a core-needle biopsy is taken. Although this procedure is performed while the patient is under local anaesthesia, the patient can still experience significant discomfort. Additionally, large haematoma can be induced in the soft tissue surrounding the biopsy site due to the large axial and rotational forces which are applied through the needle to penetrate bone. It is well documented that power ultrasonic surgical devices offer advantages of low cutting force, high accuracy and preservation of soft tissues. This paper reports a study of the design, analysis and test of two novel power ultrasonic needles for bone biopsy that operate using different configurations to penetrate bone. The first utilises micrometric vibrations generated at the distil tip of a full-wavelength resonant ultrasonic device, while the second utilises an ultrasonic-sonic approach where vibrational energy generated by a resonant ultrasonic horn is transferred to a needle via the chaotic motion of a free-mass. It is shown that the dynamic behaviour of the devices identified through experimental techniques closely match the behaviour calculated through numerical and FEA methods, demonstrating that they are effective design tools for these devices. Both devices were able to recover trabecular bone from the metaphysis of an ovine femur, and the biopsy samples were found to be comparable to a sample extracted using a conventional biopsy needle. Furthermore, the resonant needle device was also able to extract a cortical bone sample from the central diaphysis, which is the strongest part of the bone, and the biopsy was found to be superior to the sample recovered by a conventional bone biopsy needle

‘Have we become too ethical?’: International symposium at Sussex and colloquium at Durham Universities

No description supplie

RNA-Sequencing data supports the existence of novel VEGFA splicing events but not of VEGFAxxxb isoforms

AbstractVascular endothelial growth factor (VEGFA), a pivotal regulator of angiogenesis and valuable therapeutic target, is characterised by alternative splicing which generates three principal isoforms, VEGFA121, VEGFA165 and VEGFA189. A second set of anti-angiogenic isoforms termed VEGFAxxxb that utilise an alternative splice site in the final exon have been widely reported, with mRNA detection based principally upon RT-PCR assays. We sought confirmation of the existence of the VEGFAxxxb isoforms within the abundant RNA sequencing data available publicly. Whilst sequences derived specifically from each of the canonical VEGFA isoforms were present in many tissues, there were no sequences derived from VEGFAxxxb isoforms. Sequencing of approximately 50,000 RT-PCR products spanning the exon 7–8 junction in 10 tissues did not identify any VEGFAxxxb transcripts. The absence or extremely low expression of these transcripts in vivo indicates that VEGFAxxxb isoforms are unlikely to play a role in normal physiology. Our analyses also revealed multiple novel splicing events supported by more reads than previously reported for VEGFA145 and VEGFA148 isoforms, including three from novel first exons consistent with existing transcription start site data. These novel VEGFA isoforms may play significant roles in specific cell types.</jats:p

The effect of ambient temperature on cold start urban traffic emissions for a real world SI car

The influence of ambient temperature on exhaust emissions for an instrumented Euro 1 SI car was determined. A real world test cycle was used, based on an urban drive cycle that was similar to the ECE urban drive cycle. It was based on four laps of a street circuit and an emissions sample bag was taken for each lap. The bag for the first lap was for the cold start emissions. An in-vehicle direct exhaust dual bag sampling technique was used to simultaneously collect exhaust samples upstream and downstream of the three-way catalyst (TWC). The cold start tests were conducted over a year, with ambient temperatures ranging from – 2°C to 32°C. The exhaust system was instrumented with thermocouples so that the catalyst light off temperature could be determined. The results showed that CO emissions for the cold start were reduced by a factor of 8 downstream of catalyst when ambient temperature rose from -2°C to 32°C, the corresponding hydrocarbon emissions were reduced by a factor of 4. There was no clear relationship between NOx emissions and ambient temperature. For subsequent laps of the test circuit the reduction of CO and HC emissions as a function of ambient temperature was lower. The time for catalyst light off increased by 50% as the ambient temperature was reduced. The results show that the vehicle used is unlikely to meet the new – 7oC cold start CO emission regulations

A day at a time: caregiving on the edge in advanced COPD

The human cost of advanced chronic obstructive pulmonary disease (COPD) for informal caregivers in Canada is mostly unknown. Formal care is episodic, and informal caregivers provide the bulk of care between exacerbations. While patients fear becoming burdensome to family, we lack relevant data against which to assess the validity of this fear. The purpose of our qualitative study was to better understand the extent and nature of ‘burden’ experienced by informal caregivers in advanced COPD. The analysis of 14 informal caregivers interviews yielded the global theme ‘a day at a time,’ reflecting caregivers’ approach to the process of adjusting/coping. Subthemes were: loss of intimate relationship/identity, disease-related demands, and coping-related factors. Caregivers experiencing most distress described greater negative impact on relational dynamics and identity, effects they associated with increasing illness demands especially care recipients’ difficult, emotionally controlling attitudes/behaviors. Our findings reflect substantial caregiver vulnerability in terms of an imbalance between burden and coping capacity. Informal caregivers provide necessary, cost-effective care for those living with COPD and/or other chronic illness. Improved understanding of the physical, emotional, spiritual, and relational factors contributing to their vulnerability can inform new chronic care models better able to support their efforts