Step-free railway station access in the UK: The value of inclusive design

Background: Despite substantial investment in step-free access at UK railway stations, persons with reduced mobility (PRMs) continue to travel less than their able-bodied counterparts and little is known about the value of step-free access. This research examines the benefits of step-free access and its relationship with rail usage among PRMs, and the wider benefits of railway station accessibility. Methods: These issues are explored through a mixed methods approach. Semi-structured interviews with ten key organisations were undertaken, as was an analysis of Senior/Disabled Persons Railcard data from 17 railway stations in Buckinghamshire, each with varying levels of step-free accessibility. Results: The results show that the benefits of step-free access extend beyond benefits at the individual level typically associated with those limited to PRMs, and demonstrate the potential to positively affect the society at large economically, environmentally, and socially. The findings also show a positive correlation between the level of step-free accessibility at a railway station and the percentage of PRMs using it. Conclusions: This research argues that government and interested stakeholders should commit to expanding the number and coverage of step-free stations throughout the UK. They should ensure that the appraisal process for investment in step-free accessibility appropriately captures both user and non-user benefits

Gait analysis and functional outcome in patients after Lisfranc injury treatment

Introduction: Lisfranc injuries involve any bony or ligamentous disruption of the tarsometatarsal joint. Outcome results after treatment are mainly evaluated using patient-reported outcome measures (PROM), physical examination and radiographic findings. Less is known about the kinematics during gait.Methods: Nineteen patients (19 feet) treated for Lisfranc injury were recruited. Patients with conservative treatment and surgical treatment consisting of open reduction and internal fixation (ORIF) or primary arthrodesis were included. PROM, radiographic findings and gait analysis using the Oxford Foot Model (OFM) were analysed. Results were compared with twenty-one healthy subjects (31 feet). Multivariable logistic regression was used to determine factors influencing outcome.Results: Patients treated for Lisfranc injury had a significantly lower walking speed than healthy subjects (P &lt;0.001). There was a significant difference between the two groups regarding the range of motion (ROM) in the sagittal plane (flexion-extension) in the midfoot durieng the push-off phase (p &lt;0.001). The ROM in the sagittal plane was significantly correlated with the AOFAS midfoot score (r2 = 0.56, p = 0.012), FADI (r(2) = 0.47, p = 0.043) and the SF-36-physical impairment score (r(2) = 0.60, p = 0.007) but not with radiographic parameters for quality of reduction. In a multivariable analysis, the best explanatory factors were ROM in the sagittal plane during the push-off phase (beta = 0.707, p = 0.001), stability (beta = 0.423, p = 0.028) and BMI (beta = -0.727 p = &lt;0.001). This prediction model explained 87% of patient satisfaction.Conclusions: This study showed that patients treated for Lisfranc injury had significantly lower walking speed and significantly lower flexion/extension in the midfoot than healthy subjects. The ROM in these patients was significantly correlated with PROM, but not with radiographic quality of reduction. Most important satisfaction predictors were BMI, ROM in the sagittal plane during the push-off phase and fracture stability. (c) 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.</p

Virtual reality-based cognitive behavioural therapy for patients with generalized social anxiety disorder:a pilot study

BACKGROUND: Patients with generalized social anxiety disorder (SAD) avoid various social situations and can be reluctant to engage in in vivo exposure therapy. Highly personalized practising can be required before patients are ready to perform in vivo exposure. Virtual reality-based therapy could be beneficial for this group. AIMS: To assess the feasibility and potential effect of virtual reality-based cognitive behavioural therapy (VR-CBT) for patients with severe generalized SAD. METHODS: Fifteen patients with generalized SAD attended up to 16 VR-CBT sessions. Questionnaires on clinical and functional outcomes, and diary assessments on social activity, social anxiety and paranoia were completed at baseline, post-treatment and at 6-months follow-up. RESULTS: Two patients dropped out of treatment. Improvements in social anxiety and quality of life were found at post-treatment. At follow-up, depressive symptoms had decreased, and the effect on social anxiety was maintained. With respect to diary assessments, social anxiety in company and paranoia were significantly reduced by post-treatment. These improvements were maintained at follow-up. No increase was observed in social activity. CONCLUSIONS: This uncontrolled pilot study demonstrates the feasibility and treatment potential of VR-CBT in a difficult-to-treat group of patients with generalized SAD. Results suggest that VR-CBT may be effective in reducing anxiety as well as depression, and can increase quality of life

Methodology for global sensitivity analysis of consequence models

Research Highlights A methodology for global sensitivity analysis of consequence models is presented using a statistical emulator The methodology is demonstrated on the Phast consequence model for steady-state discharges of high-pressure carbon dioxide Dispersion model input parameters that have a significant effect on the extent of the plume are identified The study demonstrates that Bayesian analysis of model sensitivity can be conducted quickly and easily There is the potential for this to become a routine part of consequence modelling Abstract A methodology is presented for global sensitivity analysis of consequence models used in process safety applications. It involves running a consequence model around a hundred times and using the results to construct a statistical emulator, which is essentially a sophisticated curve fit to the data. The emulator is then used to undertake the sensitivity analysis and identify which input parameters (e.g. operating temperature and pressure, wind speed) have

Different susceptibility of osteosarcoma cell lines and primary cells to treatment with oncolytic adenovirus and doxorubicin or cisplatin

Despite improvements in treatment regimens for osteosarcoma (OS) patients, survival rate has not increased over the last two decades. New treatment modalities are therefore warranted. Preclinical results with conditionally replicative adenoviruses (CRAds) to treat OS are promising. One type of CRAd that was effective against OS cells is Ad5-Δ24RGD. In other types of cancer, CRAds have been shown to interact synergistically with chemotherapeutic agents. Chemotherapy for OS often includes doxorubicin and cisplatin. Therefore, we explored combination treatment of OS cell lines and primary OS cell cultures with Ad5-Δ24RGD and doxorubicin or cisplatin. On OS cell lines, combination treatment was additive to synergistic. Surprisingly, however, on seven of eight primary OS samples no such combination effects were observed. In contrast, in many cases chemotherapy even inhibited CRAd-mediated cell killing. The inhibitory effect of doxorubicin on Ad5-Δ24RGD in primary OS cells appeared to correlate with slow cell growth rate; reduced viral replication and absence of chemotherapy-induced G2 cell cycle arrest. Our results point to the possibility that, at least for OS, virotherapy and chemotherapy should best not be performed simultaneously. In general, our work underscores the importance of testing new genetic anticancer agents and treatment regimens on primary cancer specimens