The psychological and social impact of the digital self-support system 'Brain in Hand' on autistic people: prospective cohort study in England and Wales.

BACKGROUND: Brain in Hand (BIH) is a UK-based digital self-support system for managing anxiety and social functioning. AIMS: To identify the impact of BIH on the psychological and social functioning of adults with autism. METHOD: Adults with diagnosed or suspected DSM-5 (level 1) autism, identified by seven NHS autism services in England and Wales, were recruited for a 12-week prospective mixed-methods cohort study. The primary quantitative outcome measures were the Health of the Nation Outcome Scales for People with Learning Disabilities (HONOS-LD) and the Hospital Anxiety and Depression Scale (HADS). Fisher's exact test explored sociodemographic associations. Paired t-test was utilised for pre-post analysis of overall effectiveness of BIH. Multivariable linear regression models, univariable pre-post analysis, Wilcoxon signed-rank test, logistic regression analysis, Bonferroni correction and normative analysis were used to give confidence in changes identified. A thematic analysis of semi-structured exist interviews following Braun and Clarke's six-step process of 10% of participants who completed the study was undertaken. RESULTS: Sixty-six of 99 participants completed the study. There was significant reduction in mean HONOS-LD scores, with 0.65 s.d. decrease in those who used BIH for 12 weeks. Significant positive changes were identified in HONOS-LD subdomains of 'self-injurious behaviours', 'memory and orientation', 'communication problems in understanding', 'occupation and activities' and 'problems with relationship'. A significant reduction in the anxiety, but not depression, component of the HADS scores was identified. Thematic analysis showed high confidence in BIH. CONCLUSIONS: BIH improved anxiety and other clinical, social and functioning outcomes of adults with autism.

Simulation translation differences between craft groups.

BACKGROUND: Many simulation-based clinical education events (SBCEE) aim to prepare healthcare professionals with the knowledge, skills, and features of professionalism needed to deliver quality patient care. However, how these SBCEE learnings are translated into broader workplace practices by learners from different craft groups has not been described. OBJECTIVES: To understand how learners from different craft groups (doctors and nurses) anticipate simulation-based learnings will translate to their workplaces and the process by which translation occurs. DESIGN: Qualitative descriptive study design using pre- and post-SBCEE questionnaires. SETTINGS: A large tertiary Australian hospital-based simulation centre that facilitates SBCEE for multi-professional graduate and undergraduate clinicians from 16 hospitals. METHODS: Participants who attended SBCEEs between May and October 2021 completed questionnaires at two touchpoints, on the day of attending a SBCEE and 6 weeks after. Based on a phenomenological approach, the study examined clinicians' experiences in relation to simulation education, intended simulation learning use in the workplace, and perceived success in subsequently using these learnings to improve clinical outcomes. Qualitative inductive thematic data analysis was used to develop narratives for different learner cohorts. RESULTS: Three overarching themes were identified regarding simulation participants' perceptions of the success of translating simulation learnings into the workplace. These were: scenario-workplace mirroring, self-assessment, and successful confidence. Doctor participants found it difficult to map SBCEE learnings to their workplace environments if they did not mirror those used in simulation. Nurses sought peer evaluation to analyse the effectiveness of their workplace translations, whereas doctors relied on self-assessment. Learners from both craft groups highly prized 'confidence-building' as a key indicator of improved workplace performance achieved through SBCEE learning. CONCLUSION: A diverse range of factors influences healthcare workers' experiences in translating simulation learnings to their workplace. To equip simulation learners to translate learnings from a SBCEE into their clinical practices, we suggest the following areas of focus: co-development of translation plans with learners during the delivery of an SBCEE including the indicators of success, above table discussions on the generalisability of learnings to different environments and contexts, smart investment in simulation outputs, and cautious championing of confidence-building.

An MRI study of solute transport in the intervertebral disc.

OBJECTIVE: Quantitative magnetic resonance imaging was used to determine partition coefficients and characteristic time constants for diffusion of MRI contrast agents in disc tissue. MATERIALS AND METHODS: Twenty-two excised equine intervertebral discs were exposed to a range of contrast agents: six to manganese chloride, eight to Magnevist (gadopentetate dimeglumine) and eight to Gadovist (gadobutrol), and uptake into the disc was quantified in T1-weighted images. RESULTS: Diffusion for all contrast agents was approximately 25% faster in the nucleus than in the outer annulus; disc-average time constants ranged from (2.28 ± 0.23) × 104 s for Gadovist (uncharged, molecular mass 605 g/mol) to (5.07 ± 0.75) × 104 s for the manganese cation (charge + 2). Disc-average partition coefficients ranged from 0.77 ± 0.04 for the anion in Magnevist (charge - 2, molecular mass 548 g/mol) to 5.14 ± 0.43 for the manganese cation. CONCLUSION: The MRI technique provides high-quality quantitative data which correspond well to theoretical predictions, allowing values for partition coefficient and time constant to be readily determined. These measurements provide information to underpin similar studies in vivo and may be used as a model for the transport of nutrients and pharmaceutical agents in the disc.

Investigation of changes in bone density and chemical composition associated with bone marrow oedema-type appearances in magnetic resonance images of the equine forelimb.

BACKGROUND: The aetiology of bone marrow oedema-like abnormalities (BMOA) seen on magnetic resonance imaging (MRI) is as yet not fully understood. The current study aimed to investigate the potential of projection radiography and Raman microspectroscopy to provide information regarding the underlying physiological changes associated with BMOA in equine bone samples. METHODS: MRI was used to assess 65 limbs from 43 horses. A subset of 13 limbs provided 25 samples, 8 with BMOA present and 17 as controls; these were examined with projection radiography to assess bone mineral density and Raman spectroscopy to assess bone composition. Statistical analysis was conducted using SPSS, the relationship between BMOA and age was tested using binary logistic regression, other outcome measures via unpaired t-tests. RESULTS: Overall BMOA was found to be associated with locally increased bone density (p = 0.011), suggesting increased bone formation; however, no measurable changes relating to bone remodelling were found, and there were no detectable changes in the chemical composition of bone. CONCLUSIONS: BMOA is associated with locally increased bone density, without an associated change in the chemical composition of bone, suggesting this is not linked to BMOA. The presence of increased bone density associated with BMOA does appear to suggest that an increased amount of bone formation is occurring in these regions, but as Raman microspectroscopy data do not demonstrate any significant changes in bone chemical composition associated with BMOA, it would appear that the increased bone volume is due to a greater amount of bone being formed rather than an imbalance in relation to bone remodelling. The study provides a proof of principle for the use of Raman microspectroscopy and projection radiography in in vitro studies of BMOA.

A simulation environment for studying transcutaneous electrotactile stimulation.

Transcutaneous electrical nerve stimulation (TENS) allows the artificial excitation of nerve fibres by applying electric-current pulses through electrodes on the skin's surface. This work involves the development of a simulation environment that can be used for studying transcutaneous electrotactile stimulation and its dependence on electrode layout and excitation patterns. Using an eight-electrode array implementation, it is shown how nerves located at different depths and with different orientations respond to specific injected currents, allowing the replication of already reported experimental findings and the creation of new hypotheses about the tactile sensations associated with certain stimulation patterns. The simulation consists of a finite element model of a human finger used to calculate the distribution of the electric potential in the finger tissues neglecting capacitive effects, and a cable model to calculate the excitation/inhibition of action potentials in each nerve.

Structure of the Pacinian Corpuscle: Insights Provided by Improved Mechanical Modeling.

An improved model of the Pacinian corpuscle includes corrections for lamellar curvature. Results suggest that outer-zone lamellae produce a focusing effect whereby stimuli are channeled radially inwards. The requirements for this effect (large outer-surface area and thin, closely spaced lamellae) provide a rationale for the complexity of the outer-zone structure.

Using interprofessional simulation to improve collaborative competences for nursing, physiotherapy, and respiratory therapy students.

Within the care of people living with respiratory conditions, nursing, physiotherapy, and respiratory therapy healthcare professionals routinely work in interprofessional teams. To help students prepare for their future professional roles, there is a need for them to be involved in interprofessional education. The purpose of this project was to compare two different methods of patient simulation in improving interprofessional competencies for students in nursing, physiotherapy, and respiratory therapy programmes. The Canadian Interprofessional Health Collaborative competencies of communication, collaboration, conflict resolution patient/family-centred care, roles and responsibilities, and team functioning were measured. Using a quasi-experimental pre-post intervention approach two different interprofessional workshops were compared: the combination of standardised and simulated patients, and exclusively standardised patients. Students from nursing, physiotherapy, and respiratory therapy programmes worked together in these simulation-based activities to plan and implement care for a patient with a respiratory condition. Key results were that participants in both years improved in their self-reported interprofessional competencies as measured by the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). Participants indicated that they found their interprofessional teams did well with communication and collaboration. But the participants felt they could have better involved the patients and their family members in the patient's care. Regardless of method of patient simulation used, mannequin or standardised patients, students found the experience beneficial and appreciated the opportunity to better understand the roles of other healthcare professionals in working together to help patients living with respiratory conditions.

Lomustine Nanoparticles Enable Both Bone Marrow Sparing and High Brain Drug Levels - A Strategy for Brain Cancer Treatments.

PURPOSE: The blood brain barrier compromises glioblastoma chemotherapy. However high blood concentrations of lipophilic, alkylating drugs result in brain uptake, but cause myelosuppression. We hypothesised that nanoparticles could achieve therapeutic brain concentrations without dose-limiting myelosuppression. METHODS: Mice were dosed with either intravenous lomustine Molecular Envelope Technology (MET) nanoparticles (13 mg kg(-1)) or ethanolic lomustine (6.5 mg kg(-1)) and tissues analysed. Efficacy was assessed in an orthotopic U-87 MG glioblastoma model, following intravenous MET lomustine (daily 13 mg kg(-1)) or ethanolic lomustine (daily 1.2 mg kg(-1) - the highest repeated dose possible). Myelosuppression and MET particle macrophage uptake were also investigated. RESULTS: The MET formulation resulted in modest brain targeting (brain/ bone AUC0-4h ratios for MET and ethanolic lomustine = 0.90 and 0.53 respectively and brain/ liver AUC0-4h ratios for MET and ethanolic lomustine = 0.24 and 0.15 respectively). The MET formulation significantly increased mice (U-87 MG tumours) survival times; with MET lomustine, ethanolic lomustine and untreated mean survival times of 33.2, 22.5 and 21.3 days respectively and there were no material treatment-related differences in blood and femoral cell counts. Macrophage uptake is slower for MET nanoparticles than for liposomes. CONCLUSIONS: Particulate drug formulations improved brain tumour therapy without major bone marrow toxicity.

Montage of a Queering Deferred: Memory, Ownership, and Archival Silencing in the Rhetorical Biography of Langston Hughes.

This article explores the intersection of archival privilege and heteronormative bias in the queering of Langston Hughes. Although it has been a common belief in LGBTQ communities that Hughes was gay, the battle over how his sexuality is defined in various biographical texts involves broader issues of dominant representations of sexuality and who gets to speak for those no longer able to speak for themselves. As such, the article examines the texts Looking for Langston and The Life of Langston Hughes as well as the discourses that surrounded both. Through this case study, it is apparent that there are still numerous cultural challenges posed to historical queering and that scholars must take an inventive approach to overcome them.

Multi-modal representation of effector modality in frontal cortex during rule switching.

We report a functional magnetic resonance imaging (fMRI) study which investigated whether brain areas involved in updating task rules within the frontal lobe of the cerebral cortex show activity related to the modality of motor response used in the task. Participants performed a rule switching task using different effector modalities. In some blocks participants responded with left/right button presses, whilst in other blocks left/right saccades were required. The color of a Cue event instructed a left or right response based upon a rule, followed by a Feedback which indicated whether the rule was to stay the same or "Flip" on the next trial. The findings revealed variation in the locus of activity within the ventrolateral frontal cortex dependent upon effector modality. Other frontal areas showed no significant difference in activity between response epochs but changed their pattern of connectivity with posterior cortical areas dependent upon response. Multivariate analysis revealed that the pattern of activity evoked by Flip rule Feedbacks within an apparently supra modal frontal region (dorsolateral frontal cortex) discriminated between response epochs. The results are consistent with the existence of multi-modal representations of stimulus-response (SR) rules within the frontal cerebral cortex.

Surface-Roughness-Based Virtual Textiles: Evaluation Using a Multi-Contactor Display.

Virtual textiles, generated in response to exploratory movements, are presented to the fingertip via a 24-contactor vibrotactile array. Software models are based on surface-roughness profiles from real textiles. Results suggest that distinguishable "textile-like" surfaces are produced, but these lack the necessary accuracy for reliable matching to real textiles.

Control of the stop band of an acoustic double fishnet.

The acoustic transmittance of two closely spaced solid plates, each perforated with a square array of cylindrical holes, exhibits a band of near-perfect acoustic attenuation originating from hybridization between a resonance in the gap separating the plates and pipe resonances in the holes. Displacement of one plate relative to the other, such that the holes are no longer aligned, or an increase in the plate separation leads to an increased center frequency of the stop band. This ability to easily tune the frequency of the stop band may prove advantageous.

A functional-magnetic-resonance-imaging investigation of cortical activation from moving vibrotactile stimuli on the fingertip.

Using a 100-element tactile stimulator on the fingertip during functional-magnetic-resonance imaging, brain areas were identified that were selectively activated by a moving vibrotactile stimulus (the sensation of a moving line being dragged over the fingertip). Activation patterns elicited by tactile motion, contrasted to an equivalent stationary stimulus, were compared in six human subjects with those generated by a moving visual stimulus, contrasted to an equivalent stationary stimulus. Results provide further evidence for a neuroanatomical convergence of tactile-motion processing and visual-motion processing in humans. The sites of this convergence are found to lie in the middle temporal complex (hMT+V5), an area with known specialization for visual-motion processing, and in the intraparietal area of the posterior parietal cortex. In an advance on previous studies, the present study includes separate delineation of activations for moving tactile stimuli and activations for moving visual stimuli. Results suggest that the two sets of activations are not entirely collocated. Compared to the visual-motion activations, the tactile-motion activations are found to lie nearer the midline of the brain and further superior.

Discrimination of interval size in short tone sequences.

This study investigates the discrimination of small changes of interval size in short sequences of musical tones. Major, minor and neutral thirds were varied in increments of 15 cents. The nine subjects had varying degrees of amateur musical experience-their level of musical training was lower than that of professional musicians. In some experiments the stimuli were presented purely melodically and in others they were presented together with a sustained tone at a higher pitch. Some subjects were able to make use of the additional cues from beats in the latter case. Category widths for identification were measured at around 70 cents and just-noticeable differences in frequency were measured at around 10 cents. Little significant variation of inter-stimulus sensitivity index d' was observed across the stimulus sets, i.e., there was little evidence for "anchors" or "landmarks" within the range of tunings employed. However, for major thirds, discrimination of the 15 cent increment between 400 and 415 cents was reduced compared to discrimination of other 15 cent increments within the stimulus sets.

The role of the lateral prefrontal cortex and anterior cingulate in stimulus-response association reversals.

Many complex tasks require us to flexibly switch between behavioral rules, associations, and strategies. The prefrontal cerebral cortex is thought to be critical to the performance of such behaviors, although the relative contribution of different components of this structure and associated subcortical regions are not fully understood. We used functional magnetic resonance imaging to measure brain activity during a simple task which required repeated reversals of a rule linking a colored cue and a left/right motor response. Each trial comprised three discrete events separated by variable delay periods. A colored cue instructed which response was to be executed, followed by a go signal which told the subject to execute the response and a feedback instruction which indicated whether to "hold" or "flip" the rule linking the colored cue and response. The design allowed us to determine which brain regions were recruited by the specific demands of preparing a rule contingent motor response, executing such a response, evaluating the significance of the feedback, and reconfiguring stimulus-response (SR) associations. The results indicate that an increase in neural activity occurs within the anterior cingulate gyrus under conditions in which SR associations are labile. In contrast, lateral frontal regions are activated by unlikely/unexpected perceptual events regardless of their significance for behavior. A network of subcortical structures, including the mediodorsal nucleus of the thalamus and striatum were the only regions showing activity that was exclusively correlated with the neurocognitive demands of reversing SR associations. We conclude that lateral frontal regions act to evaluate the behavioral significance of perceptual events, whereas medial frontal-thalamic circuits are involved in monitoring and reconfiguring SR associations when necessary.

Semantic divergence and creative story generation: an fMRI investigation.

The aim of this fMRI investigation was to identify those areas of the brain associated with approaching a story generation task creatively and to investigate the effects upon these correlates of incorporating a set of words that were unrelated to each other-a strategy considered to encourage semantic divergence. Preliminary experiments were undertaken to investigate the possible confounding effects of the scanner environment upon creativity and to reveal the effects of creative effort and word relatedness upon the creativity of those who would be participating in the fMRI scan. In the final part of the investigation, a factorial fMRI design was used to elucidate brain regions involved in increased creative effort and also the effect upon activity in these regions when participants incorporated words that bore little semantic relationship with each other. Results support the notion that areas of the right prefrontal cortex are critical to the types of divergent semantic processing involved with creativity in this context.

Specific training in clinical forensic medicine is useful to ACEM trainees.

OBJECTIVE: To assess the effectiveness of a 6-month rotation in forensic medicine in developing medicolegal and forensic skills for doctors training for a fellowship with the Australasian College for Emergency Medicine (ACEM). METHODS: Over a period of 6 years 12 trainees undertook a 6-month rotation with the Victorian Institute of Forensic Medicine (VIFM) as a clinical forensic registrar. These 12 trainees were surveyed and asked structured questions regarding their perception of the usefulness of the training and the impact of the rotation on their professional development. RESULTS: Twelve replies were received (100% response rate). All respondents felt that the term had a major positive influence on their ability to examine victims of physical and sexual assault, obtain forensic specimens and prepare a medicolegal report. CONCLUSIONS: A 6-month rotation in clinical forensic medicine improves ACEM trainees perceived ability to perform a number of medicolegal tasks without interfering with other areas of professional development.

Information content and quality of MR thumb images.

This study investigates the relation between objective and subjective parameters which relate to the quality of magnetic-resonance images, with a view to developing procedures for minimizing imaging time. The investigation uses high-resolution images of the thumb as example. Detection thresholds for an artificial lesion and ratings of image quality were obtained for a variety of images, with several experienced observers. In addition, the information content was calculated for each image, using the method developed by Fuderer (1988 IEEE Tralns. Med. Imaging 7 368-80). Results suggest that information content can be used as a predictor of either detection threshold or quality rating, with a critical information content beyond which there is no significant improvement in either of these aspects of image quality. Since it is possible to estimate the effect of imaging variables on information content, it is possible to predict the effect of time-saving imaging strategies on image quality. A procedure is suggested for determining the combination of imaging variables which gives the shortest possible imaging time whilst retaining image quality.