An evaluation of the 'Living with Cancer' project: Using neuro-linguistic programming techniques to maximise the coping strategies of carers and patients living with cancer in Ellesmere Port

The 'Living with cancer' project aimed to improve communication, relationship, and coping skills of health professionals, cancer patients and their carers in Ellesmere Port. The project delivered NLP Diploma training to 55 health professionals between April 2001-March 2004.Commissioned by Chester and Halton NHS Trust and funded through the New Opportunities Fund

Exploring colorectal cancer patients' perceptions of the quality of their care

This report discusses the local situation in Halton with regard to colorectal cancer care by exploring how patients perceived the quality of their care.Widnes Primary Care Grou

Pulmonary Structure and Function in Chronic Obstructive Pulmonary Disease Evaluated using Hyperpolarized Noble Gas Magnetic Resonance Imaging

Chronic obstructive pulmonary disease (COPD) is the 4th leading cause of death worldwide and accounts for the highest rate of hospital admissions in Canada. The need for sensitive regional and surrogate measurements of lung structure and function in COPD continues to motivate the development of non-radiation based and sensitive imaging approaches, such as hyperpolarized helium-3 (3He) and xenon-129 (129Xe) magnetic resonance imaging (MRI). The static ventilation images acquired using these approaches allows us to directly visualize lung regions accessed by the hyperpolarized gas during a breath-hold, as well as quantify the regions without signal referred to as the percentage of the thoracic cavity occupied by ventilation defects (VDP). The lung micro-structure can also be probed using diffusion-weighted imaging which takes advantage of the rapid diffusion of 3He and 129Xe atoms to generate surrogate measurements of alveolar size, referred to as the apparent diffusion coefficient (ADC). Here we evaluated COPD lung structure and function using hyperpolarized gas MRI measurements longitudinally, following treatment and in early disease. In COPD ex-smokers, we demonstrated 3He VDP and ADC worsened significantly in only 2 years although there was no change in age-matched healthy volunteers, suggestive of disease progression. We also evaluated COPD ex-smokers pre- and post-bronchodilator and showed regional improvements in gas distribution following bronchodilator therapy regardless of spirometry-based responder classification; the ADC measured in these same COPD ex-smokers also revealed significant reductions in regional gas trapping post-bronchodilator. Although 3He MRI has been more widely used, the limited global quantities necessitates the transition to hyperpolarized 129Xe, and therefore we directly compared 3He and 129Xe MRI in the same COPD ex-smokers and showed significantly greater gas distribution abnormalities for 129Xe compared to 3He MRI that were spatially and significantly related to lung regions with elevated ADC. Finally, we demonstrated that ex-smokers with normal spirometry but abnormal diffusion capacity of the lung for carbon monoxide (DLCO) had significantly worse symptoms, exercise capacity and 3He ADC than ex-smokers with normal DLCO. These important findings indicate that hyperpolarized gas MRI can be used to improve our understanding of lung structural and functional changes in COPD

An evaluation of the Wallasey Heart Centre

This project report discusses an evaluation of Wallasey Heart Centre, an intermediate cardiovascular clinic designed to provide accessible high-quality patient care to an area with a high prevalence of of coronary heart disease and poor access to existing secondary care services. The service began in October 2000 with funding for three years. The views of local GPs, local cardiologists, and Wallasey Heart Centre staff and patients were sought

LEARNING FROM DEMONSTRATION IN A GAME ENVIRONMENT

Darmok 2 is a Case-Based Reasoning AI designed to learn from demonstration. Using the Brood War API and the Java Native Interface, we adapted Darmok 2 to work with the Real-Time Strategy game StarCraft: Brood War. Adapting Darmok 2 to a robust competitive strategy game allowed us to demonstrate its learning capabilities, assess its performance and limitations, and suggest improvements to its architecture

An Annotated Analysis of Contemporary Game Design Literature

This project examines the current state of computer game design literature by comparing and analyzing twelve of the most popular game design textbooks. It is determined that few textbooks labeling themselves as game design books actually provide useful insight into the practice of game design and even fewer attempt to construct a theory of it. Two observations have been made: there is a need for more textbooks about game design theory and there is a glut of superficial, useless books

Evidence of adult lung growth in humans.

A 33-year-old woman underwent a right-sided pneumonectomy in 1995 for treatment of a lung adenocarcinoma. As expected, there was an abrupt decrease in her vital capacity, but unexpectedly, it increased during the subsequent 15 years. Serial computed tomographic (CT) scans showed progressive enlargement of the remaining left lung and an increase in tissue density. Magnetic resonance imaging (MRI) with the use of hyperpolarized helium-3 gas showed overall acinar-airway dimensions that were consistent with an increase in the alveolar number rather than the enlargement of existing alveoli, but the alveoli in the growing lung were shallower than in normal lungs. This study provides evidence that new lung growth can occur in an adult human

Ventilation Heterogeneity in Ex-smokers without Airflow Limitation.

RATIONALE AND OBJECTIVES: Hyperpolarized (3)He magnetic resonance imaging (MRI) ventilation abnormalities are visible in ex-smokers without airflow limitation, but the clinical relevance of this is not well-understood. Our objective was to phenotype healthy ex-smokers with normal and abnormally elevated ventilation defect percent (VDP). MATERIALS AND METHODS: Sixty ex-smokers without airflow limitation provided written informed consent to (3)He MRI, computed tomography (CT), and pulmonary function tests in a single visit. (3)He MRI VDP and apparent diffusion coefficients (ADCs) were measured for whole-lung and each lung lobe as were CT measurements of emphysema (relative area [RA] with attenuation ≤-950 HU, RA950) and airway morphology (wall area percent [WA%], lumen area [LA] and LA normalized to body surface area [LA/BSA]). RESULTS: In 42 ex-smokers, there was abnormally elevated VDP and no significant differences for pulmonary function, RA950, or airway measurements compared to 18 ex-smokers with normal VDP. Ex-smokers with abnormally elevated VDP reported significantly greater (3)He ADC in the apical lung (right upper lobe [RUL], P = .02; right middle lobe [RML], P = .04; and left upper lobe [LUL], P = .009). Whole lung (r = 0.40, P = .001) and lobar VDP (RUL, r = 0.32, P = .01; RML, r = 0.46, P = .002; right lower lobe [RLL], r = 0.38, P = .003; LUL, r = 0.35, P = .006; and left lower lobe, r = 0.37, P = .004) correlated with regional (3)He ADC. Although whole-lung VDP and CT airway morphology measurements were not correlated, regional VDP was correlated with RUL LA (r = -0.37, P = .004), LA/BSA (r = -0.42, P = .0008), RLL WA% (r = 0.28, P = .03), LA (r = -0.28, P = .03), and LA/BSA (r = -0.37, P = .004). CONCLUSIONS: Abnormally elevated VDP in ex-smokers without airflow limitation was coincident with very mild emphysema detected using MRI and regional airway remodeling detected using CT representing a subclinical obstructive lung disease phenotype

Evaluating bronchodilator effects in chronic obstructive pulmonary disease using diffusion-weighted hyperpolarized helium-3 magnetic resonance imaging

The objective of this study was to evaluate the regional effects of bronchodilator administration in chronic obstructive pulmonary disease (COPD) using hyperpolarized helium-3 ((3)He) MRI apparent diffusion coefficient (ADC). Ten COPD ex-smokers provided written, informed consent and underwent diffusion-weighted, hyperpolarized (3)He MRI, spirometry, and plethysmography before and 25 ± 2 min after bronchodilator administration. Pre- and postsalbutamol whole-lung (WL) ADC maps were generated and registered together to identify the lung regions containing the (3)He signal at both time points, and mean ADC within those regions of interest (ROI) was determined for a measurement of previously ventilated ROI ADC (ADC(P)). Lung ROI with (3)He signal at both time points was used as a binary mask on postsalbutamol WL ADC maps to obtain an ADC measurement for newly ventilated ROI (ADC(N)). Postsalbutamol, no significant differences were detected in WL ADC (P = 0.516). There were no significant differences between ADC(N) and ADC(P) postsalbutamol (P = 1.00), suggesting that the ADC(N) lung regions were not more emphysematous than the lung ROI participating in ventilation before bronchodilator administration. Postsalbutamol, a statistically significant decrease in ADC(P) (P = 0.01) was detected, and there were significant differences between ADC(P) in the most anterior and most posterior image slices (P = 0.02), suggesting a reduction in regional gas trapping following bronchodilator administration. Regional evaluation of tissue microstructure using hyperpolarized (3)He MRI ADC provides insights into lung alterations that accompany improvements in regional (3)He gas distribution after bronchodilator administration

Chronic obstructive pulmonary disease: Quantification of bronchodilator effects by using hyperpolarized ³He MR imaging

PURPOSE: To evaluate short-acting bronchodilator effects in chronic obstructive pulmonary disease (COPD) by using hyperpolarized helium 3 (³He) magnetic resonance (MR) imaging, spirometry, and plethysmography. MATERIALS AND METHODS: Fourteen ex-smokers with COPD provided written informed consent to a local ethics board-approved and Health Insurance and Portability Accountability Act-compliant protocol and underwent hyperpolarized ³He and hydrogen 1 MR imaging, spirometry, and plethysmography before and a mean of 25 minutes ± 2 (standard deviation) after administration of 400 μg salbutamol. Distribution of ³He gas was evaluated by using semiautomated segmentation of ³He voxel intensities, where cluster 1 represented regions of signal void or ventilation defect volume (VDV), and clusters 2-5 (C2-C5) represented gradations of signal intensity from hypointensity (C2) to hyperintensity (C5). ³He ventilation defect percentage (VDP) was calculated as VDV normalized to the thoracic cavity volume. Comparisons of pre- and post-salbutamol means were performed by using a two-way mixed-design repeated measures analysis of variance, and comparisons of the magnitude of the treatment effect between pulmonary function and ³He MR imaging measurements were performed by using effect size (ES) calculations. The relationships between pulmonary function and ³He MR imaging findings were determined by using Spearman correlation coefficients. RESULTS: After salbutamol administration, there were significant changes in forced expiratory volume in 1 second (FEV₁) (P = .001), total lung capacity (P = .04), and functional residual capacity (P = .03), as well as VDP (P \u3c .0001) and ³He gas distribution (C2, P = .01; C3, P = .03; C4, P \u3c .0001; and C5, P = .02). Treatment ES was greater for ³He VDP than for FEV(1) (0.50 vs 0.22). There was a significant correlation between baseline VDP and post-salbutamol FEV₁ change (r = -0.77, P = .001). Although five patients were classified as bronchodilator responders and nine patients were classified as bronchodilator nonresponders according to American Thoracic Society and European Respiratory Society criteria, there was no significant difference in the magnitude of the ³He MR imaging changes after salbutamol administration between responder groups. CONCLUSION: ³He MR imaging depicted significant improvements in the distribution of ³He gas after bronchodilator therapy in ex-smokers with COPD with and those without clinically important changes in FEV₁