Clinical evaluation of thalamic deep brain stimulation for movement disorders in multiple sclerosis

Disorders of movement are recognized features of multiple sclerosis (MS). They often involve the upper limbs, headland trunk and can prevent a person from carrying out the simplest of daily activities such as holding a drink and feeding themselves. This may have enormous psychological consequences, often leading to frustration, embarrassment (particularly in social situations), withdrawal and increased dependence on others.Treatment of these disorders of movement, which are usually refractory to medical therapy, has been by thalamotomy, a neuroablative technique. Results have been variable and often unsatisfactory in the long term. Recently thalamic deep brain stimulation (DBS) has been proposed after its successful use in the treatment of Parkinsonian tremor. Relatively little information exists on the use of this treatment in patients with MS. Studies carried out so far have been on very small cohorts and have used non-validated outcome scales and short follow-up. There is little data on the effect of the movement disorder on a person's disability, handicap and quality of life (QOL); the perception of ability after surgery; and on the costs involved in thalamic DBSThe work presented here had 3 principal objectives: first to develop and validate a scale for measuring movement disorders in MS (MDMS); secondly to evaluate the effect of thalamic DBS on impairment, disability, handicap and aspects of quality of life (QOL) relevant to these patients; and thirdly to estimate the costs associated with thalamic DBS.The Modified Fahn's Tremor Rating Scale (MFTRS) was developed and validated for the purposes of this study. Results of the validity, reliability and responsiveness of the MFTRS, as given in the published paper, showed that it can be used with confidence in the clinical setting.Thirty seven patients with MDMS were assessed before operation. Fifteen patients underwent thalamic surgery. The target arm was assessed 1, 3, 6 and 12 months after operation using the MFTRS, which measured severity of tremor, and the Jebsen Test of Hand Function (JTHF) which measured performance of 7 subtests of upper limb function. Information concerning the influence of the movement disorder on overall disability, handicap and QOL was collected at or over 12 months and was compared with that of the pre-operative assessment using various subjective rating scales and questionnaires.Results showed that thalamic DBS significantly reduced the severity of tremor amplitude and significantly improved performance of the Jebsen subtests when the DBS was on at each post-operative assessments (1, 3, 6, and 12 months) compared with pre-operatively (all p values < 0.02). However, these symptomatic and changes in function did not translate into significant improvements in patients' performance in activities of daily living and thus there were no apparent economic benefits (ie. savings in future care-costs). Also there was no change in patients' perceptions of their handicap or in most aspects of QOL: the only significant change was that patients perceived themselves to be less anxious 12 months after the operation (p-0.03). The overall impact was therefore clinically limited.This prospective study has illustrated the benefits and limitations of thalamic DBS in patients with MDMS, and has highlighted the post-operative rehabilitation and follow-up requirements and the resulting health economic implications associated with its use. The validation of the MFTRS not only enabled the effect of thalamic DBS to be evaluated but also provided a major contribution to the assessment of MDMS

Beyond Insulin to Carb Ratio- The Impact of Dietary Fat and Protein on Postprandial Glycemia and Implications for Mealtime Dosing in Patients with Type 1 Diabetes

Despite a growing understanding of the impact of fat and protein on post-prandial blood glucose levels, current medical nutrition therapy for treatment of type 1 diabetes continues to focus primarily on carbohydrate counting for mealtime bolus calculation. Standards of care practice guidelines suggest increasing mealtime dose for meals high in fat and/or protein, but do not provide specific guidelines on adjustment of insulin dose and timing for high fat and/or protein meals. There is no recommended macronutrient breakdown for patients with type 1 diabetes, who may follow a variety of diets and dietary patterns. Both low carbohydrate diets and higher carbohydrate plant-based diets have increased in popularity over recent years, revealing variability in individual response to diet composition and the role of various dietary components beyond solely carbohydrate content on glycemic control. Variability in response to various dietary components suggests the need for individually tailored dietary education to develop effective mealtime dosing strategies that improve glycemic control within the context of each individual’s dietary preferences and responses. Therefore, this review examines recent research on the impact of dietary fat and protein on post-prandial blood glucose, discusses the current evidence for different mealtime dosing strategies that account for dietary fat and protein, and suggests critical areas for future work with the goal of improving postprandial blood glucose in patients with type 1 diabetes.Master of Public Healt

The appeal of the Functional Fitness MOT to older adults and health professionals in an outpatient setting: a mixed-method feasibility study

Purpose: To understand the views and perceptions regarding the Functional Fitness MOT (FFMOT), a battery of functional tests followed by a brief motivational interview, of both the older people undergoing it and the health professionals delivering it. Patients and methods: Physically inactive older adults (n=29) underwent the FFMOT and subsequently attended focus groups to share their perceptions of it and to discuss the barriers, motivators, health behavior change, and scope to improve physical activity (PA) levels. PA levels were recorded at baseline and again at 12 weeks together with a post-intervention questionnaire concerning behavior change. Participating physiotherapists and technical instructors were interviewed. Results: Most participants felt they had learned about their abilities and comparisons with their peers, had a change in perception about the importance of good balance and strength, and felt the FFMOT helped raise their awareness of local and self-directed physical activity opportunities. Most felt their awareness of the need for PA had not changed, but 25% of participants started a new organized PA opportunity. The health professionals perceived the FFMOT as being easy to administer, educating, and motivating for participants to increase their PA. Space, time, finances, and insecurity about having the necessary skills to conduct the FFMOTs were seen as barriers in implementing the FFMOT in daily practice. Conclusion: Over half of those offered the FFMOT accepted it, suggesting it is appealing. However, most participants felt they were already active enough and that their awareness of the need for PA had not changed. There were positive perceptions of the FFMOT from both professionals and older people, but both felt the FFMOT could be held in a community venue. The overall findings suggest that the FFMOT is feasible in the clinical setting, but its effectiveness has yet to be determined

How do diverse groups of learners in the health sciences respond to a new virtual learning environment?

Funded by the Learning Teaching Support Network for Health SciencesEdinburghAims of the project In the original proposal, the stated aims of this research were to: 'Investigate learners' responses to their first exposure to a new learning experience in a VLE Examine learners' attitudes to the VLE as an effective learning environment through the project Compare and contrast attitudes to a VLE in two different physiotherapy programmes.' Objectives of the project The main objective of the research (as stated in the original proposal) was to provide a detailed analysis into the experience of two specific and differing physiotherapy student cohorts who were new to using VLEs in the learning experience. We aimed to: 'Provide an overview of the literature on the use and value of VLEs in the health sciences. This will focus specifically on initial learner attitudes to Information Technology in learning Conduct a study exploring students' reactions to, and participation in a VLE during the lifetime of the project Identify issues in preparing students in the use of a VLE drawn from diverse groups Evaluate the findings of the study which will: Review students attitudes to the use of a VLE in physiotherapy programmes Highlight individual, social and technical barriers for the meaningful implementation of the VLE from the student perspective Consider the potential for VLEs for the health science community as a whole as well as to the individual lecturer Raise awareness, throughout the duration of the project, of the potential roles of VLE in improving students learning.'CAPAlexander, S. 2001. E-learning developments and experiences. Education and Training, 43 (4/5), pp. 240 - 248. Aspden, L., Helm, P. and Thorpe, L. 2003. Capturing learners' experiences with e-learinng: preliminary findings. 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An introduction to theory and methods. 2nd ed. Boston: Allyn and Bacon. Bradley, C. and Boyle, T. 2004. Introducing and sustaining improvements in course delivery through learning technologies. In ALT-C conference Blue skies and pragmatism: learning technologies for the next decade, September 14-16, Exeter, UK. Association for Learning Technology. Breen, R., Lindsay, R., Jenkins, A. and Smith, P. 2001. The role of information and communication technologies in a university learning environment. Studies in Higher Education, 26 (1), pp. 95 - 114. Carpenter, C. 2004. The contribution of qualitative research to evidence-based practice. In: Whalley-Hammel, K. and Carpenter, C. (Eds) Qualitative Research in Evidence-Based Rehabilitation, Edinburgh: Churchill Livingstone, pp 1- 13. Carroll-Barefield, A. and Murdoch. 2003. Using online learning to enhance interdisciplinary education. Journal of Allied Health, 33 (1) Spring, pp.78-81. Conrad, D. 2002. 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Glasgow: The Scottish Council for Research in Education. Economic and Social Research Council. 2002. E-quality in e-learning manifesto. Swindon: ESRC. Available at &lt;http://csalt.lancs.ac.uk/esrc&gt; [accessed 20 February 2005]. Ellis, A. and Llewellyn, B. 2004. Social Presence, Lecturer Presence and Participation in an Asynchronous Online Discussion Forum. In ALT-C conference Blue skies and pragmatism: learning technologies for the next decade, September 14-16, Exeter, UK. Association for Learning Technology. Elliott, J. 1991. Action Research for Educational Changes. Milton Keynes: Open University Press. Frand, J. L. 2000. The information age mindset: changes in students and implications for higher education. Educause Review, September/October, pp.15-27. Goodyear, P. 2001. Effective networked learning in higher education: notes and guidelines. Available at &lt;http://csalt.lancs.ac.uk/jisc/advice.htm&gt; [accessed 16 June 2005]. Grattan, J., Brown, G. and Horgan, J. 1998. Student C&IT skills development and the learning environment: evaluation and module evolution. Education and Training, 40 (8), pp. 366-373. Greenbaum, T. L. 1998. The handbook of focus group research. 2nd edition. London: Sage publications. Greenhalgh, T. 1997. Assessing the methodological quality of published papers. British Medical Journal, 315, pp. 305-308. Hancock, B, 2002. An introduction to qualitative research. Trent Focus for Research and Development in Primary Health Care. Available from &lt; http://www.trentfocus.org.uk/Resources/introduction_qualitative_research.htm&gt; [accessed on 10 June 2005)]. Hanna, D. 1998. Higher Education in an Era of Digital Competition: Emerging Organizational Models. Journal of Asychrnous Learning Networks, 2, (1). Available at &lt;http://www.sloan-c.org/publications/jaln/v2n1/index.asp&gt; [accessed 16 June 2005] Harvey, J. and Mogey, N. 1996. Motivating students to use learning technology. LTDI. 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Towards constructivism: investigating students' perceptions and learning as a result of using an online environment. Innovations in Education and Teaching International, 39 (3) pp. 217-224. Jedlicka, J., Brown, S. W., Bunch, A. E. and Jaffe, L. E. 2002. A comparison of distance education instructional methods in occupational therapy. Journal of Allied Health, 31 (4) pp. 247-251. The Joint Information System Committee (2002) Study of MLE Activity. Available at &lt;http://www.jisc.ac.uk/project_mle_activity.html#mle_study_report&gt; [accessed on 15 June 2005]. Jones, P. and Griffiths, M. 2003. Developing electronic-based learning in radiography. Synergy, February, pp.19-23. Knowles, M. 1984. Andgragogy in Action. San Francisco: Jossey-Bass. Krefting L. 1991. Rigor in Qualitative Research: the assessment of trustworthiness. American Journal of Occupational therapy, 45 (3) pp.214-244. Kubala, T. Addressing Student Needs: Teaching on the Internet. 1998. T H E Journal, 25 (8) Development in Primary Health Care. Available from &lt; http://www.trentfocus.org.uk/Resources/Qualitative%20Data%20Analysis.pdf&gt; [accessed on 10 June 2005]. Larson, B. and Keiper, T. 2002. Classroom discussion and threaded electronic discussion: learning in two arenas. Contemporary Issues in Technology and Teacher Education, 21. Available at &lt;http://www.citejournal.org/vol2/iss1/socialstudies/article1.cfm&gt; [accessed 8 June 2005]. Leasure, A., Davis, L. and Thievon, S. 2000. Comparison of student outcomes and preferences in a traditional versus World Wide WebCT-based baccalaureate nursing research course. Journal of Nursing Education, 39, pp.149-154. Leung, Y. and Ivy, M. 2003. How useful are course websites? A study of students perceptions. Journal of Hospitality, Leisure, Sport and Tourism Education, 22, pp.15-24. Lockyer, L., Patterson, J. and Harper, B. 1999. Measuring effectiveness of health education in a web-based learning environment: a preliminary report. Higher Education Research and Development, 18, (2) pp.233-246. Masi, A. and Winer, L. 2005. A university-wide vision of teaching and learning with information technologies. Innovations in Education and Teaching International, 42 (2), pp.147-155. Mattheos, N., Schittek, M., Attstrom, R. and Lyon, H.C. 2001 Distance learning in academic health education: a literature review. European Journal of Dental Education, 5, pp.67-76. Mays, N. and Pope, C. 1995. Rigor and Qualitative Research. British Medical Journal, 311, pp.109-112. McDowell, L. and Marples, G. 2001. First catch your student - qualitative approaches to research on information and learning technologies. Available at&lt;http://www.leeds.ac.uk/educol/documents/00001765.htm&gt; [accessed 8 June 2005] McGorry, S. Y. 2002. Online, but on target? Internet-based MBA courses: A case study. The Internet and Higher Education, 5, (2) Summer, pp.167-175. Medlin, B., Vannoy, S and Dave, D. 2004. An Internet-based Approach to the Teaching of Information Technology: A Study of Student Attitudes in the United States. International Journal of Management, 21 (4) December, pp. 427-434. Middlewood, D., Coleman, M. and Lumby, J. 1999. Practitioner Research in Education: Making a Difference. London: Paul Chapman Publishing Limited. Monteith, M. and Smith, J. 2001. Learning in a virtual campus: the pedagogical implication of students' experiences. Innovations in Education and Teaching International, 38, (2) pp.119-132. Moore, K. and Aspden, L. 2004. Coping, adapting, evolving: the student experience of elearning. Library and Information Update Online Articles. Available at &lt;http://www.cilip.org.uk/publications/updatemagazine/archive/archive2004&gt; [accessed on 7 June 2005]. Muirhead, B. 2001. Interactivity research studies. Educational Technology and Society, 43, pp.108-112. Oblinger, D. 2003. Boomers, gen-Xers and millenials: Understanding the students. Educause Review, July/August, pp. 37-41. Oliver, R. and Omari, A. 2001. Student responses to collaborating and learning in a webbased environment. Journal of Computer Assisted Learning, 17, pp.34-47. Pelletier, D. 2002. How prepared are graduate nurses to embrace the information technology revolution in Australian university teaching? Online Journal of Nursing Informatics, 52. Available at &lt;http://www.eaa-knowledge.com/ojni/ni/dm/52/graduate_students.htm&gt; accessed on 17 June 2005]. Richardson, P. 2004. Student development in an online post-professional master's program. Occupational Therapy in Health Care, 18, (1/2), pp.107-116. Ryan, S., Scott, B., Freeman, H. and Patel, D. 2000. The Virtual University: the Internet and Resource-Based Learning. London: Kogan Page. Salmon, G. 2000. E-Moderating: The Key to Teaching and Learning Online London: Kogan Page. Salmon, G. 2002. E-tivities: the key to active online learning. London: Kogan Page Saunders, G. and Klemming, F. 2003. Integrating technology into a traditional learning environment: reasons for and risks of success. Active Learning in Higher Education, 4 (1) pp.74-86. Scottish Higher Education Funding Council. 2005. e-Learning: Higher Education Training Needs Analysis. SHEFC. Steeples, C. and Jones, C. Eds. 2002. Networked Learning: perspectives and issues. London: Springer. Survey of European Universities Skills in ICT of Students and Staff (SEUSISS). 2003. SEUSISS Report. Available at&lt;http://www.intermedia.uib.no/seusiss/seusissreport.pdf&gt; [Accessed 16 June 2005]. Simons, D., Baron, J., Knicely, K. and Richardson, J. 2001. Online learning: Perspectives of Students and Faculty in Two Disciplines - Occupational Therapy and Teacher. Education. Occupational Therapy in Health Care,14 (2) pp.21-52. Stephenson, J. 2001. Teaching and Learning Online: Pedagogies for New Technologies. London: Kogan Page. Strauss A. and Corbin J. (1999) Basics of Qualitative Research Techniques and Procedures for Developing Grounded Theory. Sage: London. Student Online Learning Experiences (SOLE) Project. 2004. Available at &lt;http://sole.ilrt.org/&gt; [Accessed 15 June 2005]. SEUSISS Report. Available at&lt;http://www.intermedia.uib.no/seusiss/seusissreport.pdf&gt; [Accessed 16 June 2005]. Simons, D., Baron, J., Knicely, K. and Richardson, J. 2001. Online learning: Perspectives of Students and Faculty in Two Disciplines - Occupational Therapy and Teacher. Education. Occupational Therapy in Health Care,14 (2) pp.21-52. Stephenson, J. 2001. Teaching and Learning Online: Pedagogies for New Technologies. London: Kogan Page. Strauss A. and Corbin J. (1999) Basics of Qualitative Research Techniques and Procedures for Developing Grounded Theory. Sage: London. Student Online Learning Experiences (SOLE) Project. 2004. Available at &lt;http://sole.ilrt.org/&gt; [Accessed 15 June 2005].pub850pu

Do wheelchair-dependent people with multiple sclerosis want to exercise?

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Quantification of gait kinematics and walking ability of people with multiple sclerosis who are new users of functional electrical stimulation

Objective: To assess whether the application of Functional Electrical Stimulation improves gait kinematics and walking ability in people with multiple sclerosis who experience foot drop. Design: Acute open labelled comparative observation trial. Participants: Twelve people (3 females, 9 males, EDSS 2-4) with relapsing remitting multiple sclerosis (47.8 years (standard deviation 6.6)) who were new users of functional electrical stimulation. Methods: Gait kinematics were recorded using 3D gait analysis. Walking ability was assessed through the 10-m walk test and the 6-min walk test. All assessments were performed with and without the assistance of functional electrical stimulation. The effect of functional electrical stimulation was analysed using paired t-tests. Results: Ankle dorsiflexion at initial contact (p-=-0.026), knee flexion at initial contact (p-=-0.044) and peak knee flexion during swing (p-=-0.011) were significantly greater whilst walking with Functional Electrical Stimulation. The increased peak dorsiflexion in swing of nearly 4 degrees during functional electrical stimulation assisted walking approached significance (p-=-0.069). The 10-m walk time was significantly improved by functional electrical stimulation (p-=-0.004) but the 6 min walk test was not. Conclusion: The acute application of functional electrical stimulation resulted in an orthotic effect through a change in ankle and knee kinematics and increased walking speed over a short distance in people with multiple sclerosis who experience foot dropsch_phy45pub3130pub

Analysis and modeling of induced seismicity in petroleum reservoirs

Thesis (S.M. in Geosystems)--Massachusetts Institute of Technology, Dept. of Earth, Atmospheric, and Planetary Sciences, 2002.Includes bibliographical references (p. 53).Since 1998, a producing oil field in Oman has been experiencing microearthquake activity. The aim of this project is to compare numerical models of wave propagation using simple source representations to a small subset of these microearthquakes, with three goals in mind: 1) to understand whether the microearthquakes are generated by movement along a known fault system in the field, or by some other mechanism; 2) if the source is fault related, to better understand what kind of movement is occurring on the fault; and 3) to see if this simple modeling method provides useful results, and forms a basis for future work. Synthetic waveforms are generated using a one-dimensional, discrete wavenumber numerical model (Bouchon, 1980) with two simple source representations: an explosive point source and a vertical force. Comparison of the synthetic waveforms to the microearthquake data indicates that the vertical force results in a better match than the explosive point source. In addition, a simple model consisting of the superposition of four vertical forces (representing vertical fault rupture), results in waveforms that are very similar to the recorded events. These results suggest that the source of the microearthquakes is motion along a near-vertical normal fault system that has been mapped in the field. These results are also consistent with work by Sze and Toksoz (2001) in which relocation of the same events imaged a near-vertical normal fault in the field. Further work using fault rupture source modeling may provide additional insight into the amount of fault motion that is occurring in relation to these events.by Heather J. Hooper.S.M.in Geosystem

A comparative analysis of discourses shaping physical education provision within and across the UK

Set within the context of a longitudinal project that seeks to engage physical education teachers from the four countries of the UK in cross-border curriculum analysis, dialogue and learning, the current study lays the foundation by mapping and comparing curriculum discourses that currently shape how physical education is conceptualised in England, Northern Ireland, Scotland and Wales. As a team of researchers with affiliations to each of the four nations of the UK, we identified those curriculum documents from each context that were written to directly inform physical education teachers’ curriculum planning and enactment. We firstly identified those discourses evident in each document to understand how physical education is conceptualised within each curriculum, before engaging in a dialogical process that converged around how physical education is constructed similarly or differently within and across curricula. We found some variation in relation to how the concept of health is articulated. With the exception of the curriculum in Wales, we also found that performance discourses related to developing motor competencies for sports continue to dominate as the main purpose of physical education. Finally, there are several points of divergence in relation to how much agency or guidance teachers are afforded within each curriculum. The intention of this research is to initiate dialogue across each of the four nations, creating opportunities for learning so that, collectively, teachers can build capacity to contribute to future curricula and pedagogies in physical education

Exploring physical education teachers’ conceptualisations of health and wellbeing discourse across the four nations of the UK

As a group of researchers representing England, Northern Ireland, Scotland and Wales, we previously carried out a comparative analysis of the health discourses evident within the physical education (PE) curriculum of each UK nation (Gray et al., 2022). We uncovered complex  ‘health’ landscapes, represented through different discourses of health across contexts and shifting discourses within contexts. The purpose of the present proof of concept study is to extend this cross-border work by exploring how UK PE teachers conceptualise health and wellbeing (HWB), and to identify the ways in which their conceptualisations align (or not) with their respective curricula. We found some alignment between the teachers’ understanding of HWB and their respective curricular documentation, which was highlighted in the similarities and differences across contexts. Furthermore, all of the PE teachers had some understanding of HWB as a holistic and broad concept. We argue that understanding the various conceptualisations of HWB within and across contexts can serve as a useful foundation for cross-border dialogue, which may support the development of PE teachers’ critical reading of curriculum and their capacity and authority to contribute to future curriculum developments. </p

Exploring the re-legitimisation of messages for health and physical education within contemporary English and Welsh curricula reform

This paper explores how messages for health and PE ([H]PE) within English and Welsh curricula are being re-legitimised through distinct performance and competence pedagogic models. Drawing upon Bernstein’s sociology of knowledge (Bernstein, 1996. Pedagogy, symbolic control and identity: Theory, research, critique. Taylor and Francis; 2000. Pedagogy, symbolic control and identity: Theory, research and critique (revised ed.). Rowman and Littlefield) data was generated through a deductive content analysis of the contemporary statutory English National Curriculum for Physical Education (NCPE) and the new Curriculum for Wales (CfW), Health and Well-Being Area of Learning and Experience (HWB-AoLE). Findings illustrate how the current English and Welsh curricula are re-legitimising discourses for (H)PE through a more prominent emphasis placed on competency models whereby the educator and learner are given greater autonomy to control the transmission and acquisition of (H)PE messages. However, the curriculum documents are beset with contradictions that to an extent reproduce discourses of performativity and individualisation. Consequently, the paper emphasises the need for educators and policymakers to be given the opportunity for critical dialogue on the implications of re-legitimising messages through competency models for all educator and learner identities