Reorganisation of sensorimotor function in children with brain disease

Introduction: In this study, paradigms were developed for the investigation of sensorimotor function in children using functional MRI (fMRI), somatosensory evoked potential (SEP) recordings and behavioural measures. These techniques were applied both to normal controls subjects and to children with brain disease. A major aim was to investigate the remarkable recovery of function that can take place following brain injury sustained early in life. Methods: Three fMRI paradigms were developed, namely active movement of the hand, passive flexion/extension movement of the fingers and median nerve stimulation. In addition, SEPs of functional cortical responses to stimulation of the median nerve were recorded at high temporal resolution. Finally, the extent of residual or recovered sensory and motor hand function was assessed using behavioural tests, including grip strength and double simultaneous stimulation. In one set of investigations, all three techniques were applied to children following hemispherectomy or children following vascular damage to the middle cerebral artery territory, to examine the pattern of residual sensorimotor function following brain injury. In a second study, fMRI was carried out in pre-surgical paediatric patients for mapping of the sensorimotor cortex in preparation for surgical resection of lesions in the vicinity of this cortical region. Results and Discussion: fMRI was successful in locating the hand cortical sensorimotor area in 11 out of 12 paediatric patients pre-operatively, and was of value to the neurosurgeon in helping to delineate the boundaries of subsequent cortical resection. In patients following stroke and hemispherectomy, a combination of fMRI, SEP and behavioural techniques provided evidence for inter-hemispheric reorganisation of sensorimotor function through ipsilateral sensorimotor pathways, and also suggested an increase in the involvement of ipsilateral secondary sensorimotor areas. The data also indicate that cortical sensorimotor reorganisation and functional recovery can be seen in patient both with congenital disease and with late-onset acquired disease, suggesting that factors additional to age at injury may influence the degree of residual function resulting from cerebral reorganisation. Informed consent was obtained for all patients and controls, and the study was approved by the Great Ormond Street Hospital for Children/Institute of Child Health Research Ethics Committee

Assistive Technology (AT), for What?

Amartya Sen’s seminal Tanner lecture: Equality of What? began a contestation on social justice and human wellbeing that saw a new human development paradigm emerge—the capability approach (CA)—which has been influential ever since. Following interviews with leading global assistive technology (AT) stakeholders, and users, this paper takes inspiration from Sen’s core question and posits, AT for what? arguing that AT should be understood as a mechanism to achieve the things that AT users’ value. Significantly, our research found no commonly agreed operational global framework for (disability) justice within which leading AT stakeholders were operating. Instead, actors were loosely aligned through funding priorities and the CRPD. We suggest that this raises the possibility for (welcome and needed) incoming actors to diverge from efficiently designed collective action, due to perverse incentives enabled by unanchored interventions. The Global Report on Assistive Technology (GReAT) helps, greatly! However, we find there are still vital gaps in coordination; as technology advances, and AT proliferates, no longer can the device-plus-service approach suffice. Rather, those of us interested in human flourishing might explore locating AT access within an operational global framework for disability justice, which recognizes AT as a mechanism to achieve broader aims, linked to people’s capabilities to choose what they can do and be

Unpacking 'What Works': A Commentary of the Key Learnings for ICT from the AT2030 Program

The AT2030 programme was launched in 2018 to test ‘what works’ in getting assistive technology (AT) to people globally, specifically in low- and middle-income countries (LMIC), where there is often a systematic lack of provision. After four years, this paper reviews the project outcomes, focussing on published material. It provides the backdrop to the AT2030 program, contextualises current developments in global AT global and funding, and unpacks the key learnings of what works to get AT to the people that need it around the world, with a focus on ICT. The paper does this by applying Global Disability Innovation Hub’s mission-led and transformative approach, concluding with contemporary actions to improve access to AT to illustrate the value of embracing complexity for AT ecosystem stakeholders, including researchers, practitioners, AT users and policymakers

Unpacking 'What Works': A Commentary of the Key Learnings for ICT from the AT2030 Program

The AT2030 programme was launched in 2018 to test 'what works' in getting assistive technology (AT) to people globally, specifically in low- and middle-income countries (LMIC), where there is often a systematic lack of provision. After four years, this paper reviews the project outcomes, focussing on published material. It provides the backdrop to the AT2030 program, contextualises current developments in global AT global and funding, and unpacks the key learnings of what works to get AT to the people that need it around the world, with a focus on ICT. The paper does this by applying Global Disability Innovation Hub's mission-led and transformative approach, concluding with contemporary actions to improve access to AT to illustrate the value of embracing complexity for AT ecosystem stakeholders, including researchers, practitioners, AT users and policymakers

Evaluating the efficacy of breastfeeding guidelines on long-term outcomes for allergic disease

Background: WHO guidelines advocate breastfeeding for six months, and EAACI recommends exclusive breastfeeding for 4-6 months. However, evidence for breastfeeding to prevent asthma and allergic disease is conflicting. We examined whether following recommended breastfeeding guidelines alters the long-term risks of asthma, eczema, rhinitis, or atopy.Methods: The effect of non-exclusive (0, >0-6, >6 months), and exclusive breastfeeding (0, >0-4, >4 months) on repeated measures of asthma (10, 18 years), eczema, rhinitis, and atopy (1-or-2, 4, 10,18 years) risks were estimated in the IoW cohort (n=1456) using log-linear models with generalised estimating equations. The Food Allergy and Intolerance Research (FAIR) cohort (n=988), also from the IoW, was examined to replicate results.Results: Breastfeeding (any or exclusive) had no effect on asthma and allergic disease in the IoW cohort. In the FAIR cohort, any breastfeeding for >0-6 months protected against asthma at 10 years (RR=0.50, 95%CI=0.32-0.79, p=0.003) but not other outcomes, while exclusive breastfeeding for >4 months protected against repeated rhinitis (RR=0.36, 95%CI=0.18-0.71, p=0.003). Longer breastfeeding was protective against late-onset wheeze in the IoW cohort.Conclusion: The protective effects of non-exclusive and exclusive breastfeeding against long-term allergic outcomes were inconsistent between these co-located cohorts, agreeing with previous observations of heterogeneous effects. Although breastfeeding should be recommended for other health benefits, following breastfeeding guidelines did not appear to afford consistent protection against long-term asthma, eczema, rhinitis or atopy. Further research is needed into the long-term effects of breastfeeding on allergic disease

Parental distress around supplementing breastfed babies using nasogastric tubes on the post-natal ward: a theme from an ethnographic study

‘The definitive version is available at: www3.interscience.wiley.com ' Copyright Blackwell Publishing. DOI: 10.1111/j.1740-8709.2008.00165.xThere is abundant evidence of the benefits of breastfeeding. In the UK, supplementation in hospital has consistently been shown to be associated with shortened duration of breastfeeding. This paper reports on a subset of the data from an ethnographic study that explored the expectations, beliefs and experiences of mothers and health professionals concerning supplementation, using a variety of methods, of breastfed babies in an English maternity unit in 2002. This paper aims to describe the expectations, beliefs and experiences of mothers and health professionals concerning supplementation by nasogastric (NG) tube on the post-natal ward. Participant observation was carried out on day and night shifts and at weekends over 9 months. Mothers, midwives, neonatal nurses, health care assistants and senior paediatricians were interviewed. Categories and themes were generated. The researchers' constructs of 'the essential method', when the tube was the method needed for medical reasons, and 'the chosen method', when other methods of oral feeding should have been possible, emerged. The latter included time pressures and the avoidance of any form of oral activity that might perhaps make return to the breast more difficult. The data concerning the use of NG tubes for supplementation yielded the specific theme of parental distress. In the absence of evidence that supplementation by NG tube on the post-natal ward is associated with greater breastfeeding success than other methods, the use of the tube to avoid any form of 'oral confusion' should be discontinued. Its use primarily to save time should not be considered acceptable.Peer reviewe

Cutaneous and renal glomerular vasculopathy as a cause of acute kidney injury in dogs in the UK

To describe the signalment, clinicopathological findings and outcome in dogs presenting with acute kidney injury (AKI) and skin lesions between November 2012 and March 2014, in whom cutaneous and renal glomerular vasculopathy (CRGV) was suspected and renal thrombotic microangiopathy (TMA) was histopathologically confirmed. The medical records of dogs with skin lesions and AKI, with histopathologically confirmed renal TMA, were retrospectively reviewed. Thirty dogs from across the UK were identified with clinicopathological findings compatible with CRGV. These findings included the following: skin lesions, predominantly affecting the distal extremities; AKI; and variably, anaemia, thrombocytopaenia and hyperbilirubinaemia. Known causes of AKI were excluded. The major renal histopathogical finding was TMA. All thirty dogs died or were euthanised. Shiga toxin was not identified in the kidneys of affected dogs. Escherichia coli genes encoding shiga toxin were not identified in faeces from affected dogs. CRGV has previously been reported in greyhounds in the USA, a greyhound in the UK, without renal involvement, and a Great Dane in Germany. This is the first report of a series of non-greyhound dogs with CRGV and AKI in the UK. CRGV is a disease of unknown aetiology carrying a poor prognosis when azotaemia develops

Estimation of the solubility parameters of model plant surfaces and agrochemicals: a valuable tool for understanding plant surface interactions

Background Most aerial plant parts are covered with a hydrophobic lipid-rich cuticle, which is the interface between the plant organs and the surrounding environment. Plant surfaces may have a high degree of hydrophobicity because of the combined effects of surface chemistry and roughness. The physical and chemical complexity of the plant cuticle limits the development of models that explain its internal structure and interactions with surface-applied agrochemicals. In this article we introduce a thermodynamic method for estimating the solubilities of model plant surface constituents and relating them to the effects of agrochemicals. Results Following the van Krevelen and Hoftyzer method, we calculated the solubility parameters of three model plant species and eight compounds that differ in hydrophobicity and polarity. In addition, intact tissues were examined by scanning electron microscopy and the surface free energy, polarity, solubility parameter and work of adhesion of each were calculated from contact angle measurements of three liquids with different polarities. By comparing the affinities between plant surface constituents and agrochemicals derived from (a) theoretical calculations and (b) contact angle measurements we were able to distinguish the physical effect of surface roughness from the effect of the chemical nature of the epicuticular waxes. A solubility parameter model for plant surfaces is proposed on the basis of an increasing gradient from the cuticular surface towards the underlying cell wall. Conclusions The procedure enabled us to predict the interactions among agrochemicals, plant surfaces, and cuticular and cell wall components, and promises to be a useful tool for improving our understanding of biological surface interactions

A two-arm parallel-group individually randomised prison pilot study of a male remand alcohol intervention for self-efficacy enhancement:The APPRAISE study protocol

Introduction The prevalence of at-risk drinking is far higher among those in contact with the criminal justice system (73%) than the general population (35%). However, there is little evidence on the effectiveness of alcohol brief interventions (ABIs) in reducing risky drinking among those in the criminal justice system, including the prison system and, in particular, those on remand. Building on earlier work, A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE) is a pilot study designed to assess the feasibility and acceptability of an ABI, delivered to male prisoners on remand. The findings of APPRAISE should provide the information required to design a future definitive randomised controlled trial (RCT). Methods and analysis APPRAISE will use mixed methods, with two linked phases, across two prisons in the UK, recruiting 180 adult men on remand: 90 from Scotland and 90 from England. Phase I will involve a two-arm, parallel-group, individually randomised pilot study. The pilot evaluation will provide data on the likely impact of A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE), which will be used to inform a future definitive multicentre RCT. Phase II will be a process evaluation assessing how the ABI has been implemented to explore the change mechanisms underpinning the ABI (figure 1) and to assess the context within which the ABI is delivered. Ethics and dissemination The APPRAISE protocol has been approved by the East of Scotland Research Ethics Committee (19/ES/0068), National Offender Management System (2019-240), Health Board Research and Development (2019/0268), Scottish Prison Service research and ethics committee, and by the University of Edinburgh’s internal ethics department. The findings will be disseminated via peer-reviewed journal publications, presentations at local, national and international conferences, infographics and shared with relevant stakeholders through meetings and events.Additional co-authors: Jeremy Bray, Jennifer Ferguson, Arun Sondhi, Kieran Lynch, Jessica Rees, Dorothy Newbury-Birc