Haptic handwriting aid for training and rehabilitation

This paper reports a method of controlling a user\u27s hand through the process of writing. Developed predominantly for enabling users to re-learn the skill of writing after a stroke, the process could also be used for teaching children hand/eye coordination, motor skills, movement and position awareness in writing. Utilising low cost haptic technology and custom control software, the system has the potential to increase writing skills in stroke sufferers in the privacy and comfort of their own home. <br /

Study protocol for a randomised placebo-controlled trial of pramipexole in addition to mood stabilisers for patients with treatment resistant bipolar depression (the PAX-BD study)

Abstract Background Treatment Resistant Bipolar Depression (TRBD) is a major contributor to the burden of disease associated with Bipolar Disorder (BD). Treatment options for people experiencing bipolar depression are limited to three interventions listed by National Institute for Health and Care: lamotrigine, quetiapine and olanzapine, of which the latter two are often not well tolerated. The majority of depressed people with BD are therefore prescribed antidepressants despite limited efficacy. This demonstrates an unmet need for additional interventions. Pramipexole has been shown to improve mood symptoms in animal models of depression, in people with Parkinson’s Disease and two proof of principle trials of pramipexole for people with BD who are currently depressed. Methods The PAX-BD study, funded by the United Kingdom (UK) National Institute for Health Research, aims to extend previous findings by assessing the efficacy, safety and health economic impact of pramipexole in addition to mood stabilisers for patients with TRBD. A randomised, double-blind, placebo controlled design is conducted in a naturalistic UK National Health Service setting. An internal pilot study to examine feasibility and acceptability of the study design is included. Participants with TRBD are screened from National Health Service secondary care services in up to 40 mental health trusts in the UK, with the aim of recruiting approximately 414 participants into a pre-randomisation phase to achieve a target of 290 randomised participants. Primary safety and efficacy measures are at 12 weeks following randomisation, with follow up of participants to 52 weeks. The primary outcome is depressive symptoms as measured by Quick Inventory for Depressive Symptomatology – Self Report. Secondary outcomes include changes in anxiety, manic symptoms, tolerability, acceptability, quality of life and cost-effectiveness. Outcome measures are collected remotely using self-report tools implemented online, and observer-rated assessments conducted via telephone. ANCOVA will be used to examine the difference in rating scale scores between treatment arms, and dependent on compliance in completion of weekly self-report measures. A mixed effects linear regression model may also be used to account for repeated measures. Trial registration ISRCTN72151939. Registered on 28 August 2019, http://www.isrctn.com/ISRCTN72151939 Protocol Version: 04-FEB-2021, Version 9.0

Protocol for north of England and Scotland study of tonsillectomy and adeno-tonsillectomy in children (NESSTAC). A pragmatic randomised controlled trial comparing surgical intervention with conventional medical treatment in children with recurrent sore throats

BACKGROUND: Uncertainties surrounding the effectiveness and cost-effectiveness of childhood tonsillectomy for recurrent sore throat led the NHS Health Technology Assessment Programme to commission this research to evaluate the effectiveness and cost-effectiveness of tonsillectomy and adeno-tonsillectomy in comparison with standard non-surgical management in children aged under 16 with recurrent throat infections. The aim is to evaluate if tonsillectomy and adeno-tonsillectomy reduces the number of episodes of sore throats among children to a clinically significant extent. METHODS/DESIGN: A simple prospective pragmatic randomised controlled trial with economic analysis and prospective cohort study of non-trial participants comparing surgical intervention with conventional medical treatment. The treatment arm will receive tonsillectomy and adeno-tonsillectomy while in the control arm non-surgical conventional medical treatment only will be used. The primary outcome measure will be reported number of episodes of sore throat over two years with secondary outcomes measures of reported number of episodes of sore throat, otitis media and upper respiratory tract infection which invoke a GP consultation; reported number of symptom-free days; reported severity of sore throats and surgical and anaesthetic morbidity. The study will take place in five hospitals in the UK. The trial population will be 406 children aged 4–15 on their last birthday with recurrent sore throat referred by primary care to the 5 otolaryngology departments. The duration of the study is seven years (July 2001- July 2008). DISCUSSION: As with all pragmatic randomised controlled trials it is impossible to control the external environment in which the research is taking place. Since this trial began a number of factors have arisen which could affect the outcome including; a reduction in the incidence of respiratory tract infections, marked socio-economic differences in consultation rates, the results from the National Prospective Tonsillectomy Audit and the Government's waiting list initiatives

Targeting DNA Damage Response and Replication Stress in Pancreatic Cancer

Background and aims: Continuing recalcitrance to therapy cements pancreatic cancer (PC) as the most lethal malignancy, which is set to become the second leading cause of cancer death in our society. The study aim was to investigate the association between DNA damage response (DDR), replication stress and novel therapeutic response in PC to develop a biomarker driven therapeutic strategy targeting DDR and replication stress in PC. Methods: We interrogated the transcriptome, genome, proteome and functional characteristics of 61 novel PC patient-derived cell lines to define novel therapeutic strategies targeting DDR and replication stress. Validation was done in patient derived xenografts and human PC organoids. Results: Patient-derived cell lines faithfully recapitulate the epithelial component of pancreatic tumors including previously described molecular subtypes. Biomarkers of DDR deficiency, including a novel signature of homologous recombination deficiency, co-segregates with response to platinum (P &lt; 0.001) and PARP inhibitor therapy (P &lt; 0.001) in vitro and in vivo. We generated a novel signature of replication stress with which predicts response to ATR (P &lt; 0.018) and WEE1 inhibitor (P &lt; 0.029) treatment in both cell lines and human PC organoids. Replication stress was enriched in the squamous subtype of PC (P &lt; 0.001) but not associated with DDR deficiency. Conclusions: Replication stress and DDR deficiency are independent of each other, creating opportunities for therapy in DDR proficient PC, and post-platinum therapy

Understanding the barriers and enablers to implementation of a self-managed exercise intervention: a qualitative study

Background: Despite a proliferation of research evidence, there remains a ‘gap’ between what this evidence suggests and what happens in clinical practice. One reason why physiotherapists might not implement research evidence is because the findings do not align with their current practice preferences. Objectives: While conducting a multi-centre RCT we aimed to explore possible implementation barriers and facilitators with regard to the intervention under evaluation; a self-managed loaded exercise programme for rotator cuff tendinopathy. Design: A qualitative study within the framework of a mixed methods design. Data was collected using individual semi-structured interviews and analysed using the framework method. Setting: Three NHS physiotherapy departments. Participants: Thirteen physiotherapists. Results: Six themes were generated: 1) the physiotherapists preferred therapeutic option; 2} the role of the physiotherapist; 3) attributes of the intervention; 4) attitude to symptom response; 5) response to therapy, and 6) continuing professional development. Differences between the preferred therapeutic approach of the physiotherapists and the self-managed exercise intervention were apparent; particularly in relation to the type and number of exercises, the use of manual therapy and the extent of loading. The physiotherapists recognised their role as knowledge translators but certain attributes of the intervention appeared to serve as both a barrier and facilitator; particularly the simplicity. Opinion regarding the optimal symptom response during exercise prescription also differed. Conclusion: Some relevant and important physiotherapist related barriers and facilitators concerning implementation of research findings have been identified. The influence of these factors needs to be recognised and considered

User-centered evaluation of a virtual environment training system : utility of user perception measures

This study assessed the utility of measures of Self-efficacy (SelfEfficacy) and Perceived VE efficacy (PVEefficacy) for quantifying how effective VEs are in procedural task training. SelfEfficacy and PVEefficacy have been identified as affective construct potentially underlying VE efficacy that is not evident from user task performance. The motivation for this study is to establish subjective measures of VE efficacy and investigate the relationship between PVEefficacy, SelfEfficacy and User task performance. Results demonstrated different levels of prior experience in manipulating 3D objects in gaming or computer environment (LOE3D) effects on task performance and user perception of VE efficacy. Regression analysis revealed LOE3D, SelfEfficacy,PVEefficacy explain significant portions of the variance in VE efficacy. Results of the study provide further evidence that task performance may share relationships with PVEefficacy and SelfEfficacy, and that affective constructs, such as PVEefficacy, and SelfEfficacy may serve as alternative, subjective measures of task performance that account for VE efficacy.<br /

Wireless estimation of canine pose for search and rescue

In this paper we discuss the use of accelerometers and Bluetooth to monitor canine pose in the context of common poses observed in urban search and rescue dogs. We discuss the use of the canine pose system in a disaster environment, and propose techniques for determining canine pose. In addition we discuss the challenges with this approach in such environments. The paper presents the experimental results obtained from the heavy urban search and rescue disaster simulation, where experiments were conducted using multiple canines, which show that angles can be derived from acceleration readings. Our experiments show that similar angles were measured for each of the poses, even when measured on multiple USAR canines of varying size. We also found measurable and consistent differences between each of the poses, making them clearly distinguishable from one another, again even when comparing with different USAR canines.<br /