185 research outputs found
Providing True Opportunity for Opportunity Youth: Promising Practices and Principles for Helping Youth Facing Barriers to Employment
Get PDFMany "opportunity youth" -- youth who are not working or in school -- would benefit substantially from gaining work experience but need help overcoming barriers to employment and accessing the labor market.Those opportunity youth facing the most significant challenges, such as extreme poverty, homelessness, and justice system involvement, often need even more intensive assistance in entering and keeping employment, and are at risk of being left behind even by employment programs that are specifically designed to serve opportunity youth.This paper builds on the research literature with extensive interviews with employment program providers who have had success in helping the most vulnerable opportunity youth succeed in the workforce. Six principles for effectively serving these youth are identified
Stimulus-dependent maximum entropy models of neural population codes
Get PDFNeural populations encode information about their stimulus in a collective
fashion, by joint activity patterns of spiking and silence. A full account of
this mapping from stimulus to neural activity is given by the conditional
probability distribution over neural codewords given the sensory input. To be
able to infer a model for this distribution from large-scale neural recordings,
we introduce a stimulus-dependent maximum entropy (SDME) model---a minimal
extension of the canonical linear-nonlinear model of a single neuron, to a
pairwise-coupled neural population. The model is able to capture the
single-cell response properties as well as the correlations in neural spiking
due to shared stimulus and due to effective neuron-to-neuron connections. Here
we show that in a population of 100 retinal ganglion cells in the salamander
retina responding to temporal white-noise stimuli, dependencies between cells
play an important encoding role. As a result, the SDME model gives a more
accurate account of single cell responses and in particular outperforms
uncoupled models in reproducing the distributions of codewords emitted in
response to a stimulus. We show how the SDME model, in conjunction with static
maximum entropy models of population vocabulary, can be used to estimate
information-theoretic quantities like surprise and information transmission in
a neural population.Comment: 11 pages, 7 figure
Rehabilitation via home based gaming exercise for the upper-limb post stroke (RHOMBUS): results of an intervention feasibility trial
Get PDFInnovate UK grant number 10418
Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial
Get PDF© Author(s) (or their employer(s)) 2018. Introduction Effective interventions to promote upperlimb
recovery poststroke are characterised by intensive
and repetitive movements. However, the repetitive nature
of practice may adversely impact on adherence. Therefore,
the development of rehabilitation devices that can be used
safely and easily at home, and are motivating, enjoyable
and affordable is essential to the health and well-being
of stroke survivors. The Neurofenix platform is a nonimmersive
virtual reality device for poststroke upper-limb
rehabilitation. The platform uses a hand controller (a
NeuroBall) or arm bands (NeuroBands) that facilitate
upper-limb exercise via games displayed on a tablet. The
Rehabilitation via HOMe Based gaming exercise for the
Upper-limb post Stroke trial aims to determine the safety,
feasibility and acceptability of the Neurofenix platform for
home-based rehabilitation of the upper-limb poststroke.
Methods and analysis Thirty people poststroke will
be provided with a Neurofenix platform, consisting of a
NeuroBall or NeuroBands (dependent on impairment level),
seven specially designed games, a tablet and handbook
to independently exercise their upper limb for 7 weeks.
Training commences with a home visit from a research
therapist to teach the participant how to safely use the
device. Outcomes assessed at baseline and 8 weeks and
12 weeks are gross level of disability, pain, objectively
measured arm function and impairment, self-reported
arm function, passive range of movement, spasticity,
fatigue, participation, quality of life (QOL) and health
service use. A parallel process evaluation will assess
feasibility, acceptability and safety of the intervention
through assessment of fidelity to the intervention
measured objectively through the Neurofenix platform,
a postintervention questionnaire and semistructured
interviews exploring participants’ experiences of the
intervention. The feasibility of conducting an economic
evaluation will be determined by collecting data on QOL
and resource use.Innovate UK grant number 104188[3463]
Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): a qualitative analysis of participants’ experience
Get PDFObjective To report participants’ experiences of trial processes and use of the Neurofenix platform for home-based rehabilitation following stroke. The platform, consisting of the NeuroBall device and Neurofenix app, is a non-immersive virtual reality tool to facilitate upper limb rehabilitation following stroke. The platform has recently been evaluated and demonstrated to be safe and effective through a non-randomised feasibility trial (RHOMBUS).
Design Qualitative approach using semistructured interviews. Interviews were audio recorded, transcribed verbatim and analysed using the framework method.
Setting Participants’ homes, South-East England.
Participants Purposeful sample of 18 adults (≥18 years), minimum 12 weeks following stroke, not receiving upper limb rehabilitation prior to the RHOMBUS trial, scoring 9–25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate.
Results Five themes were developed which explored both trial processes and experiences of using the platform. Factors that influenced participant’s decision to take part in the trial, their perceptions of support provided during the trial and communication with the research team were found to be important contextual factors effecting participants’ overall experience. Specific themes around usability and comfort of the NeuroBall device, factors motivating persistence and perceived effectiveness of the intervention were highlighted as being central to the usability and acceptability of the platform.
Conclusion This study demonstrated the overall acceptability of the platform and identified areas for enhancement which have since been implemented by Neurofenix. The findings add to the developing literature on the interface between virtual reality systems and user experience.
Trial registration number ISRCTN60291412.Innovate UK (grant number: 104188
Rehabilitation using virtual gaming for Hospital and hOME Based training for the Upper limb post Stroke (RHOMBUS II): a feasibility randomised controlled trial
Get PDFMeeting abstract presented at the 17th UK Stroke Forum Conference, 29th November – 1st December 2022, Liverpool ACC, UK.Introduction: Stroke survivors can experience persistent upper-limb (UL) weakness. Intense practice and repetition of movement are key to effective UL rehabilitation. Yet, practice falls short of the dosage needed to drive recovery. Technology offers solutions to increase training opportunities. The NeuroBall is a co-designed portable device for all-in-one arm training through a uniquely designed rehabilitation gaming app, displayed on a tablet computer. This study aimed to determine the safety, feasibility and acceptability of the NeuroBall in the subacute inpatient and ESD stroke pathways when practice can be most effective.
Method: Single-site feasibility RCT with non-blinded outcomes at seven weeks. Twenty-four sub-acute stroke with new unilateral weakness were randomised (Intervention n=16; control n=8). Both groups received UL usual care; the intervention group, once trained, used the NeuroBall for seven weeks. Outcomes included arm impairment, arm function, pain, fatigue and self-efficacy for exercising alone, participant satisfaction, device usage and adverse events (AEs) and missing data.
Results: Twenty-four participants were recruited, eighteen completed all stages. Outcome measures were suitable, and there was minimal missing data (less than 10%). Participants undertook an additional 13 hours of UL rehabilitation, completing an average of 15, 133 UL repetitions. The mean satisfaction score (QUEST) was 35/40. Eight AEs were reported, six in the intervention group and two in the control, five were unrelated, one related, one probable and one possibly.
Conclusion: The NeuroBall is safe, enjoyable and easy to use for training the UL in the subacute stroke pathway both as an inpatient and early weeks at home
Rehabilitation Using Virtual Gaming For Hospital And Home- Based Training For The Upper Limb In Acute And Subacute Stroke (Rhombus Ii): Results Of A Feasibility RCT
Get PDFConference poster presented at the 19th UK Stroke Forum Conference, 1st–3rd December 2024, Liverpool ACC, UK.Introduction: Current provision of upper-limb (UL) rehabilitation during the early period post stroke is insufficient to optimise potential for recovery. Virtual reality systems, such as the Neurofenix platform, can help increase the intensity of UL rehabilitation across the stroke pathway.
Method: A feasibility RCT was undertaken to determine the safety, feasibility and acceptability of the Neurofenix platform. Stroke survivors with UL weakness were recruited from in-patient or early supported discharge stroke teams. Both groups received usual care, the intervention group also had the Neurofenix platform for 7-weeks. Outcomes were assessed at baseline and 7-weeks. Safety was assessed through adverse events (AEs), pain, spasticity and fatigue. Feasibility was determined through training and support requirements, and acceptability through intervention fidelity and a satisfaction questionnaire.
Results: 24 participants were randomised, n=16 to the intervention (13 women; mean (SD) age 66.5 (15) years; median (range) 9.5 (1-42) days post-stroke) and n=8 control group (4 women; mean (SD) age 64.6 (13.6) years; median (range) 17.5 (4-23) days post-stroke). 3 participants withdrew before 7-weeks, with 21 (intervention group n=15; control group n=6) included in the analysis. No significant between group differences in fatigue, spasticity, pain scores or total number of AEs. Median (IQR) time to train participants was 98 (64) minutes over 1-3 sessions. Participants trained with the platform for a median (range) of 11 (1-58) hours, equating to 94 minutes extra per week.
Conclusion: The Neurofenix platform is safe, feasible and well-accepted across the hospital and home settings, supporting increased dose and intensity of essential early UL stroke rehabilitation
Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; findings from the New Zealand multicentre stillbirth case-control study
Get PDFObjective: Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation). Methods: A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n=164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n=569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going to- sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders. Results: Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05). Conclusions: Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%
Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial
Get PDFData availability statement:
Data are available upon reasonable request. Data will be made available on the Figshare data repository.Objective: To investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.
Design: A feasibility randomised controlled trial with a parallel process evaluation.
Setting: Acute Stroke Unit and participants’ homes (London, UK).
Participants: 24 adults (>18 years), acute and subacute poststroke, new unilateral weakness, scoring 9–25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate.
Interventions: Participants randomised to the intervention or control group on a 2:1 ratio. The intervention group (n=16) received usual care plus the Neurofenix platform for 7 weeks. The control group (n=8) received usual care only.
Outcomes: Safety was assessed through adverse events (AEs), pain, spasticity and fatigue. Feasibility was assessed through training and support requirements and intervention fidelity. Acceptability was assessed through a satisfaction questionnaire. Impairment, activity and participation outcomes were also collected at baseline and 7 weeks to assess their suitability for use in a definitive trial.
Randomisation: Computer-generated, allocation sequence concealed by opaque, sealed envelopes.
Blinding: Participants and assessors were not blinded; statistician blinded for data processing and analysis.
Results: 192 stroke survivors were screened for eligibility, and 24 were recruited and randomised. Intervention group: n=16, mean age 66.5 years; median 9.5 days post stroke. Control group: n=8, mean age 64.6 years; median 17.5 days post stroke. Three participants withdrew before the 7-week assessment, n=21 included in the analysis (intervention group n=15; control group n=6). No significant group differences in fatigue, spasticity, pain scores or total number of AEs. The median (IQR) time to train participants was 98 (64) min over 1–3 sessions. Participants trained with the platform for a median (range) of 11 (1-58) hours, equating to 94 min extra per week. The mean satisfaction score was 34.9 out of 40.
Conclusion: The Neurofenix platform is safe, feasible and well accepted as an adjunct to usual care in acute and subacute stroke rehabilitation. There was a wide range of engagement with the platform in a cohort of stroke survivors which was varied in age and level of impairment. Recruitment, training and support were manageable and completion of data was good, indicating that a future randomised controlled trial would be feasible.
Trial registration number: ISRCTN11440079.This work was supported by The Stroke Association and MedCity grant number SA MC 21\10001
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CRLF3 plays a key role in the final stage of platelet genesis and is a potential therapeutic target for thrombocythemia.
Get PDFThe process of platelet production has so far been understood to be a 2-stage process: megakaryocyte maturation from hematopoietic stem cells followed by proplatelet formation, with each phase regulating the peripheral blood platelet count. Proplatelet formation releases into the bloodstream beads-on-a-string preplatelets, which undergo fission into mature platelets. For the first time, we show that preplatelet maturation is a third, tightly regulated, critical process akin to cytokinesis that regulates platelet count. We show that deficiency in cytokine receptor-like factor 3 (CRLF3) in mice leads to an isolated and sustained 25% to 48% reduction in the platelet count without any effect on other blood cell lineages. We show that Crlf3-/- preplatelets have increased microtubule stability, possibly because of increased microtubule glutamylation via the interaction of CRLF3 with key members of the Hippo pathway. Using a mouse model of JAK2 V617F essential thrombocythemia, we show that a lack of CRLF3 leads to long-term lineage-specific normalization of the platelet count. We thereby postulate that targeting CRLF3 has therapeutic potential for treatment of thrombocythemia
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