Inter-rater reliability and agreement of the General Movement Assessment and Motor Optimality Score-Revised in a large population-based sample

BACKGROUND

Prechtl's General Movement Assessment (GMA) at fidgety age (3-5 months) is a widely used tool for early detection of cerebral palsy. Further to GMA classification, detailed assessment of movement patterns at fidgety age is conducted with the Motor Optimality Score-Revised (MOS-R). Inter-rater reliability and agreement are properties that inform test application and interpretation in clinical and research settings. This study aims to establish the inter-rater reliability and agreement of the GMA classification and MOS-R in a large population-based sample.

METHODS

A cross-sectional study of 773 infants from birth-cohort in Perth, Western Australia. GMA was conducted on home-recorded videos collected between 12 + 0 and 16 + 6 weeks post term age. Videos were independently scored by two masked experienced assessors. Inter-rater reliability and agreement were assessed using intraclass correlation coefficient and limits of agreement respectively for continuous variables, and Cohen's Kappa and Gwet's Agreement Coefficient, and percentage agreement respectively for discrete variables.

RESULTS

The classification of GMA showed almost perfect reliability (AC1 = 0.999) and agreement (99.9 %). Total MOS-R scores showed good-excellent reliability (ICC 0.857, 95 % CI 0.838-0.876) and clinically acceptable agreement (95 % limits of agreement of ±2.5 points). Substantial to almost perfect reliability and agreement were found for all MOS-R domain subscores. While MOS-R domains with higher redundancy in their categorisation have higher reliability and agreement, inter-rater reliability and agreement are substantial to almost perfect at the item level and are consistent across domains.

CONCLUSION

GMA at fidgety age shows clinically acceptable inter-rater reliability and agreement for GMA classification and MOS-R for population-based cohorts assessed by experienced assessors.

Early Moves: a protocol for a population-based prospective cohort study to establish general movements as an early biomarker of cognitive impairment in infants

INTRODUCTION

The current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life.

METHOD AND ANALYSIS

Early Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies' GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739).

TRIAL REGISTRATION NUMBER

ACTRN12619001422112.

The electrospinning of a thermo-responsive polymer with peptide conjugates for phenotype support and extracellular matrix production of therapeutically relevant mammalian cells

Current cell expansion methods for tissue engineering and regenerative medicine applications rely on the use of enzymatic digestion passaging and 2D platforms. However, this enzymatic treatment significantly reduces cell quality, due to the destruction of important cell-surface proteins. In addition, culture in 2D results in undesired de-differentiation of the cells caused by the lack of 3D similarity to the natural extracellular matrix (ECM) environment. Research has led to the development of thermo-responsive surfaces for the continuous culture of cells. These thermo-responsive materials properties can be used to passage cells from the surface when the cell culture temperature is reduced. Here we report the development of a PLA/thermo-responsive (PDEGMA) blend 3D electrospun fibre-based scaffold to create an enzymatic-free 3D cell culture platform for the expansion of mammalian cells with the desired phenotype for clinical use. Human corneal stromal cells (hCSCs) were used as an exemplar as they have been observed to de-differentiate to an undesirable myo-fibroblastic phenotype when cultured by conventional 2D cell culture methods. Scaffolds were functionalised with a cell adherence peptide sequence GGG-YIGSR by thiol-ene chemistry to improve cell adherence and phenotype support. This was obtained by functionalising the thermo-responsive polymer with a thiol (PDEGMA/PDEGSH) by co-polymerisation. These incorporated thiols react with the norbornene acid functionalised peptide (Nor-GGG-YIGSR) under UV exposure. Presence of the thiol in the scaffold and subsequent peptide attachment on the scaffolds were confirmed by fluorescence labelling, ToF-SIMS and XPS analysis. The biocompatibility of the peptide containing scaffolds was assessed by the adhesion, proliferation and immuno-staining of hCSCs. Significant increase in hCSC adherence and proliferation was observed on the peptide containing scaffolds. Immuno-staining showed maintained expression of the desired phenotypic markers ALDH, CD34 and CD105, while showing no or low expression of the undesired phenotype marker α-SMA. This desired expression was observed to be maintained after thermo-responsive passaging and higher when cells were cultured on PLA scaffolds with 10 wt% PDEGMA/4 mol% PDEGS-Nor-GGG-YIGSR. This paper describes the fabrication and application of a first generation, biocompatible peptide conjugated thermo-responsive fibrous scaffold. The ease of fabrication, successful adherence and expansion of a therapeutically relevant cell type makes these scaffolds a promising new class of materials for the application of cell culture expansion platforms in the biomaterials and tissue engineering field.

Voice and Swallowing Outcomes Following Airway Reconstruction in Adults: A Systematic Review

OBJECTIVES

Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.

STUDY DESIGN

Systematic review.

METHODS

Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria.

RESULTS

A total of 143 abstracts were reviewed, with 67 articles selected for full-text review. Twenty studies met the inclusion criteria. Data extraction was completed with the Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous, and there was limited information provided about rationale or reliability.

CONCLUSIONS

The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there are no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement. Laryngoscope, 131:146-157, 2021.

C-10 Interaction of ApoE4 and Gender in Neuropsychiatric Presentation in Probable Alzheimer’s Disease

Objective

Individuals with probable Alzheimer’s disease (pAD) often have neuropsychiatric symptoms; however, the relationship of these symptoms and ApoE4 status is unclear. Recent research suggests gender moderates the relationship of ApoE4 to AD. We examined how ApoE4 genetic status and gender predict neuropsychiatric symptoms in older adults with pAD.

Method

Data from the National Alzheimer’s Coordinating Centers (NACC) was utilized in the present study. We included only individuals diagnosed with pAD with collaterals who were judged reliable by clinical NACC staff and who saw the participant at least three times per week. The selected sample (N = 6943) was 52% male; 85.6% White, 10.2% African American; and 7.5% Hispanic. Average age was 73 years. The Neuropsychiatric Inventory-Questionnaire, completed by the participant’s collateral, was used to assess symptoms. Analyses controlled for age and cognitive impairment as measured by the Mini-Mental State Examination.

Results

The presence of at least one ApoE4 allele predicted higher severity of delusions, p = .04. Males had higher severity of agitation, apathy, and irritability; females had higher delusions, depression, and anxiety, all p’s < .05. Gender moderated the relationship of ApoE4 with disinhibition, night disturbances, and appetite, all p’s < .05. In all three cases, for males, scores were higher for non-carriers than for ApoE4 carriers; however, for females, differences did not exist between carriers and non-carriers.

Conclusions

Differences between ApoE4 carriers and non-carriers as well as between genders are demonstrated, and evidence supports the hypothesis that gender and ApoE4 status interact to predict some pAD neuropsychiatric symptomatology.

Validity and reliability of a freehand 3D ultrasound system for the determination of triceps surae muscle volume in children with cerebral palsy

This study assessed the validity, intra-rater and inter-rater reliability of segmentation of in vivo medial gastrocnemius (MG), lateral gastrocnemius (LG) and soleus (SOL) muscle volume measurement using a single sweep freehand 3D ultrasound (3DUS) in children with cerebral palsy (CP). The MG, LG and SOL of both limbs of 18 children with CP (age 8 years 4 months ± 1 year 10 months, 11 males, unilateral CP = 9, bilateral CP = 9, Gross Motor Functional Classification System I = 11, II = 7) were scanned using freehand 3DUS and magnetic resonance imaging (MRI). All freehand 3DUS and MRI images were segmented and volumes rendered by two raters. Validity was assessed using limits of agreement method. Intra-rater and inter-rater reliability was assessed using intra-class correlation (ICC), coefficient of variance (CV) and minimal detectable change (MDC). Freehand 3DUS overestimated muscle volume of the MG and LG by < 0.3 mL (1%) and underestimated SOL by < 1.3 mL (1.5%) compared with MRI. ICCs for intra-rater reliability of the segmentation process for the freehand 3DUS system and MRI for muscle volume were > 0.98 and 0.99, respectively, for all muscles. ICCs for inter-rater reliability of the segmentation process for freehand 3DUS and MRI volumes were > 0.96 and 0.98, respectively, for all muscles. MDCs for single rater freehand 3DUS and MRI were < 4.0 mL (14%) and 3.2 mL (11%), respectively, in all muscles. Freehand 3DUS is a valid and reliable method for the measurement of lower leg muscle volume that can be measured with a single sweep in children with CP in vivo. It can be used as an alternative to MRI for the detection of clinically relevant changes in calf muscle volume as the result of growth and interventions.

Muscle volume alterations after first botulinum neurotoxin A treatment in children with cerebral palsy: a 6-month prospective cohort study

AIM

This study aimed to track alterations in muscle volume for 6 months in children with cerebral palsy (CP) after the first exposure to botulinum neurotoxin A (BoNT-A), a commonly used focal spasticity treatment.

METHOD

Eleven ambulant children (eight males, three females) with spastic CP, mean age 8 years 10 months (SD 3y 1mo) participated. Participants received injections to the affected gastrocnemius. The muscle volume of the gastrocnemius, soleus, tibialis anterior, and hamstrings was measured using magnetic resonance imaging. Muscle volume was normalized to bone length, and changes analysed relative to baseline. Assessments were conducted 1 week before, and 4 weeks, 13 weeks, and 25 weeks after BoNT-A treatment.

RESULTS

All children demonstrated positive clinical and functional gains. Muscle volume of the injected gastrocnemius was found to be significantly reduced at 4 weeks (-5.9%), 13 weeks (-9.4%), and 25 weeks (-6.8%). Significant increases in normalized soleus muscle volume were identified at each follow-up, while hamstrings showed significant increase at 4 weeks only.

INTERPRETATION

Absolute and normalized muscle volume of the injected muscle reduces after first BoNT-A exposure, and does not return to baseline volume by 25 weeks. Hypertrophy is seen in the soleus up to 25 weeks; the volume of the plantar flexor compartment is stable.

WHAT THIS PAPER ADDS

Muscle atrophy after first botulinum neurotoxin A (BoNT-A) exposure in children with cerebral palsy is noted. Mild BoNT-A-induced muscle atrophy is still apparent 6 months after BoNT-A exposure. Hypertrophy is evident in soleus after gastrocnemius BoNT-A exposure. Total plantarflexor volume is unchanged.

Syndecan-1 induction in lung microenvironment supports the establishment of breast tumor metastases

Background

Syndecan-1 (Sdc1), a cell surface heparan sulfate proteoglycan normally expressed primarily by epithelia and plasma cells, is aberrantly induced in stromal fibroblasts of breast carcinomas. Stromal fibroblast-derived Sdc1 participates in paracrine growth stimulation of breast carcinoma cells and orchestrates stromal extracellular matrix fiber alignment, thereby creating a migration and invasion-permissive microenvironment. Here, we specifically tested the role of stromal Sdc1 in metastasis.

Methods

The metastatic potential of the aggressive mouse mammary carcinoma cell lines, 4T1 and E0776, was tested in wild-type and genetically Sdc1-deficient host animals. Metastatic lesions were characterized by immunohistochemical analysis.

Results

After orthotopic inoculation, the lung metastatic burden was reduced in Sdc1−/− animals by 97% and more than 99%, in BALB/cJ and C57BL/6 animals, respectively. The difference in metastatic efficiency was maintained when the tumor cells were injected into the tail vein, suggesting that host Sdc1 exerts its effect during later stages of the metastatic cascade. Co-localization studies identified Sdc1 expression in stromal fibroblasts within the metastatic microenvironment and in normal airway epithelial cells but not in other cells (endothelial cells, α-smooth muscle actin positive cells, leucocytes, macrophages). The Ki67 proliferation index and the rate of apoptosis of the metastatic tumor cells were diminished in Sdc1−/− vs. Sdc1+/+ animals, and leucocyte density was indistinguishable. Sdc1-mediated metastatic efficiency was abolished when the animals were housed at a thermoneutral ambient temperature of 31 °C, suggesting that the host Sdc1 effect on metastasis requires mild cold stress.

Conclusions

In summary, Sdc1 is induced in the lung microenvironment after mammary carcinoma cell dissemination and promotes outgrowth of metastases in a temperature-dependent manner.

Electronic supplementary material

The online version of this article (10.1186/s13058-018-0995-x) contains supplementary material, which is available to authorized users.

Regulation of fetal hemoglobin expression during hematopoietic stem cell development and its importance in bone metabolism and osteoporosis

We have shown that an altered tissue redox environment in mice lacking either murine beta Hemoglobin major (Hgbβ_maKO) or minor (Hgbβ_miKO) regulates inflammation. The REDOX environment in marrow stem cell niches also control differentiation pathways. We investigated osteoclastogenesis (OC)/osteoblastogenesis (OB), in bone cultures derived from untreated or FSLE-treated WT, Hgbβ_maKO or Hgbβ_miKO mice. Marrow mesenchymal cells from 10d pre-cultures were incubated on an osteogenic matrix for 21d prior to analysis of inflammatory cytokine release into culture supernatants, and relative OC:OB using (TRAP:BSP, RANKL:OPG) mRNA expression ratios and TRAP or Von Kossa staining. Cells from WT and Hgbβ_maKO mice show decreased IL-1β,TNFα and IL-6 production and enhanced osteoblastogenesis with altered mRNA expression ratios and increased bone nodules (Von Kossa staining) in vitro after in vivo stimulation of mRNA expression of fetal Hgb genes (Hgbε and Hgbβ_mi) by a fetal liver extract (FSLE). Marrow from Hgbβ_miKO showed enhanced cytokine release and preferential enhanced osteoclastogenesis relative to similar cells from WT or Hgbβ_maKO mice, with no increased osteoblastogenesis after mouse treatment with FSLE. Pre-treatment of WT or Hgbβ_maKO, but not Hgbβ_miKO mice, with other molecules (rapamycin; hydroxyurea) which increase expression of fetal Hgb genes also augmented osteoblastogenesis and decreased cytokine production in cells differentiating in vitro. Infusion of rabbit anti- Hgbε or anti- Hgbβ_mi, but not anti-Hgbα or anti- Hgbβ_ma into WT mice from day 13 gestation for 3 weeks led to attenuated osteoblastogenesis in cultured cells. We conclude that increased fetal hemoglobin expression, or use of agents which improve fetal hemoglobin expression, increases osteoblast bone differentiation in association with decreased inflammatory cytokine release.

Entzündungsnachweis und HAMA-Bildung nach Applikation des monoklonalen Antikörpers BW 250/183

Es wird über Erfahrungen mit dem 99mTc-markierten monoklonalen Antikörper BW 250/183 zum Entzündungsnachweis berichtet. Die Validisierung erfolgte an 160 von 354 untersuchten Patienten. Es ergab sich mit einer Sensitivität von 91 % und einer Spezifität von 82% eine hohe diagnostische Treffsicherheit. Ein in 72 Fällen durchgeführter Vergleich zwischen konventioneller 3-Phasen-Knochenszintigraphie und der Granulozytenszintigraphie ergab einen positiven immunszintigraphischen Entzündungsnachweis in 76% der positiven Knochenszintigramme. Bei 84 Erstuntersuchten und 6 Zweituntersuchten wurden die HAMA-Titer 1 bis 12 Monate nach Applikation untersucht. Es zeigte sich bei den Zweituntersuchten lediglich 1 Patient mit einem mäßig erhöhten HAMA-Titer. Hieraus wird der Schluß gezogen, daß der monoklonale Antikörper BW 250/183 sehr gut zum szintigraphischen Entzündungsnachweis geeignet ist.

A design of experiments approach to identify the influencing parameters that determine poly-D,L-lactic acid (PDLLA) electrospun scaffold morphologies

Electrospun fibrous materials have increasing applications in regenerative medicine due to the similarity of fibre constructs to the morphology of certain extracellular matrices. Although experimentally the electrospinning method is relatively simple, at the theoretical level the interactions between process parameters and their influence on the fibre morphology is not yet fully understood. Here, we hypothesised that a design of experiments (DoE) model could determine combinations of process parameters that result in significant effects on poly-D,L-lactic acid (PDLLA) fibre morphology. The process parameters used in this study were applied voltage, needle-to-collector distance, flow rate and polymer concentration. Data obtained for mean fibre diameter, standard deviation (SD) of the fibre diameter (measure of fibre morphology) and presence of 'beading' on the fibres (beads per μm²) were evaluated as a measure of PDLLA fibre morphology. Uniform fibres occurred at SDs of ≤500 nm, 'beads-on-string' morphologies were apparent between ±500 and 1300 nm and large beads were observed at ±1300-1800 nm respectively. Mean fibre diameter was significantly influenced by the applied voltage and interaction between flow rate and polymer concentration. Fibre morphology was mainly influenced by the polymer concentration, while bead distribution was significantly influenced by the polymer concentration as well as the flow rate. The resultant DoE model regression equations were tested and considered suitable for the prediction of parameters combinations needed for desired PDLLA fibre diameter and additionally provided information regarding the expected fibre morphology.

Control of targeting ligand display by pH-responsive polymers on gold nanoparticles mediates selective entry into cancer cells

Selective targeting of cells for intracellular delivery of therapeutics represents a major challenge for pharmaceutical intervention in disease. Here we show pH-triggered receptor-mediated endocytosis of nanoparticles via surface ligand exposure. Gold nanoparticles were decorated with two polymers: a 2 kDa PEG with a terminal folate targeting ligand, and a di-block copolymer including a pH-responsive and a hydrophilic block. At the normal serum pH of 7.4, the pH-responsive block (apparent pK_a of 7.1) displayed a hydrophilic extended conformation, shielding the PEG-folate ligands, which inhibited cellular uptake of the nanoparticles. Under pH conditions resembling those of the extracellular matrix around solid tumours (pH 6.5), protonation of the pH-responsive polymer triggered a coil-to-globule polymer chain contraction, exposing folate residues on the PEG chains. In line with this, endocytosis of folate-decorated polymer-coated gold nanoparticles in cancer cells overexpressing folate receptor was significantly increased at pH 6.5, compared with pH 7.4. Thus, the tumour acidic environment and high folate receptor expression were effectively exploited to activate cell binding and endocytosis of these nanoparticles. These data provide proof-of-concept for strategies enabling extracellular pH stimuli to selectively enhance cellular uptake of drug delivery vectors and their associated therapeutic cargo.

Neuronal Progenitor Cells of the Neonatal Subventricular Zone Differentiate and Disperse following Transplantation into the Adult Rat Striatum

We have investigated the suitability of a recently identified and characterized population of neuronal progenitor cells for their potential use in the replacement of degenerating or damaged neurons in the mammalian brain. The unique population of neuronal progenitor cells is situated in a well-delineated region of the anterior part of the neonatal subventricular zone (referred to as SVZa). This region can be separated from the remaining proliferative, gliogenic, subventricular zone encircling the lateral ventricles of the forebrain. Because the neurons arising from the highly enriched neurogenic progenitor cell population of the SVZa ordinarily migrate considerable distances and ultimately express the neurotransmitters GABA and dopamine, we have examined whether they could serve as an alternative source of tissue for neural transplantation. SVZa cells from postnatal day 0-2 rats, prelabeled by intraperitoneal injections of the cell proliferation marker BrdU, were implanted into the striatum of adult rats approximately 1 mo after unilateral denervation by 6-OHDA. To examine the spatio-temporal distribution and phenotype of the transplanted SVZa cells, the experimental recipients were perfused at short (less than 1 wk), intermediate (2-3 wk) and long (5 mo) postimplantation times. The host brains were sectioned and stained with an antibody to BrdU and one of several cell-type specific markers to determine the phenotypic characteristics of the transplanted SVZa cells. To identify neurons we used the neuron-specific antibody TuJ1, or antimembrane-associated protein 2 (MAP-2), and anti-GFAP was used to identify astrocytic glia. At all studied intervals the majority of the surviving SVZa cells exhibited a neuronal phenotype. Moreover, morphologically they could be distinguished from the cells of the host striatum because they resembled the intrinsic granule cells of the olfactory bulb, their usual fate. At longer times, a greater number of the transplanted SVZa cells had migrated from their site of implantation, often towards an outlying blood vessel, and the density of cells within the core of the transplant was reduced. Furthermore, there were rarely signs of transplant rejection or a glial scar surrounding the transplant. In the core of the transplant there were low numbers of GFAP-positive cells, indicating that the transplanted SVZa cells, predominantly TuJ1-positive/MAP2-positive, express a neuronal phenotype. Collectively, the propensity of the SVZa cells to express a neuronal phenotype and to survive and integrate in the striatal environment suggest that they may be useful in the reconstruction of the brain following CNS injury or disease.

Dually sensitive dextran-based micelles for methotrexate delivery

Temperature and pH-sensitive micelles prepared from dextran grafted with poly(N-isopropylacrylamide) (PNIPAAm)/polyethylene glycol methyl ether (PEGMA) with/without 2-aminoethylmethacrylate (2-AEM) were evaluated as methotrexate delivery systems.

Vector-field statistics for the analysis of time varying clinical gait data

BACKGROUND

In clinical settings, the time varying analysis of gait data relies heavily on the experience of the individual(s) assessing these biological signals. Though three dimensional kinematics are recognised as time varying waveforms (1D), exploratory statistical analysis of these data are commonly carried out with multiple discrete or 0D dependent variables. In the absence of an a priori 0D hypothesis, clinicians are at risk of making type I and II errors in their analyis of time varying gait signatures in the event statistics are used in concert with prefered subjective clinical assesment methods. The aim of this communication was to determine if vector field waveform statistics were capable of providing quantitative corroboration to practically significant differences in time varying gait signatures as determined by two clinically trained gait experts.

METHODS

The case study was a left hemiplegic Cerebral Palsy (GMFCS I) gait patient following a botulinum toxin (BoNT-A) injection to their left gastrocnemius muscle.

FINDINGS

When comparing subjective clinical gait assessments between two testers, they were in agreement with each other for 61% of the joint degrees of freedom and phases of motion analysed. For tester 1 and tester 2, they were in agreement with the vector-field analysis for 78% and 53% of the kinematic variables analysed. When the subjective analyses of tester 1 and tester 2 were pooled together and then compared to the vector-field analysis, they were in agreement for 83% of the time varying kinematic variables analysed.

INTERPRETATION

These outcomes demonstrate that in principle, vector-field statistics corroborates with what a team of clinical gait experts would classify as practically meaningful pre- versus post time varying kinematic differences. The potential for vector-field statistics to be used as a useful clinical tool for the objective analysis of time varying clinical gait data is established. Future research is recommended to assess the usefulness of vector-field analyses during the clinical decision making process.

From Dreamtime to Nightmare: The voices of 168 Aboriginal (ex-)prisoners in New South Wales

The data presented in this paper form part of an action-research project commissioned jointly by the New South Wales Department of Corrective Services and the Ministry of Aboriginal Affairs in 1985. The major aims of this research were to investigate the chief causes and the rate of Aboriginal recidivism as well as making recommendations as to what kind of post-release support schemes would prove efficient, effective and useful.

In the course of the research, the archival records of 154 Aboriginal prisoners released from New South Wales gaols during the first six months of 1983 were analysed. Furthermore, 30 New South Wales State Government Officers and Aboriginal service providers as well as 68 Aboriginal ex-inmates and 100 Aboriginal inmates were interviewed.

The information presented in this paper is based mainly on an analysis of some answers given to us by the 68 Aboriginal ex-inmates and 100 Aboriginal inmates. The 68 Aboriginal ex-inmates interviewed resided in Canberra, Grafton, Maitland, Queanbeyan and Sydney. The interviews with the 100 Aboriginal prisoners were held in the following prisons: Bathurst, Cessnock, Glen Innes, Goulburn, Grafton, Maitland, Mulawa, Long Bay and Oberon.

Motorcyclist's thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes

The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified. Demographics, injury, and treatment characteristics were recorded. Association between laterality and injury type was assessed. Of 128 patients, 59 underwent acute treatment for thumb injuries. Eleven patients sustained thumb ulnar collateral ligament injuries; 27 sustained thumb carpometacarpal injuries. Most carpometacarpal injuries were fracture-dislocations (19/27). Thumb carpometacarpal injuries had no overall side predilection; ulnar collateral ligament injuries occurred more on the right. Carpometacarpal fractures and dislocations are the most frequent motorcycle crash thumb injury, probably due to the mechanics of gripping handlebars and the high-energy force directed into the palm and against the metacarpal base.

LEVEL OF EVIDENCE

Level IV.

Bridging the research-practice gap: A reflective account of research work

A growing body of knowledge attests to the idea that research is socially constructed. As such, researchers and the context of research may affect the types of questions which are posed, the methodologies used and the interpretation of the results. In nursing this has led to calls for a greater espousal of reflexivity by researchers, and a plea for a more open and critical reporting of the `process' of research. This study is a response to this plea. It describes the process by which the authors of a study which examined the culture of research in three NHS trusts, reflected on, and attempted to expose, hitherto hidden factors which affected the work. The methods used were bracketing, reflective diaries and a post-analysis reflective discussion. Thematic analysis of these data indicated that several factors related to both the experience and the background of the authors, and the context of the study affected its course. The reflective process was also valuable in unearthing certain `taken for granted knowledge' which, if acted on earlier, would have improved the rigour of the work. The authors advocate that researchers and funders need to reflect in a more structured way on the studies that they pursue. Furthermore, this open style of reporting may assist in bridging the gap between academics and practitioners by illustrating some of the dilemmas, uncertainties and contingencies which affect most research projects.

Engineering serendipity: High-throughput discovery of materials that resist bacterial attachment

Controlling the colonisation of materials by microorganisms is important in a wide range of industries and clinical settings. To date, the underlying mechanisms that govern the interactions of bacteria with material surfaces remain poorly understood, limiting the ab initio design and engineering of biomaterials to control bacterial attachment. Combinatorial approaches involving high-throughput screening have emerged as key tools for identifying materials to control bacterial attachment. The hundreds of different materials assessed using these methods can be carried out with the aid of computational modelling. This approach can develop an understanding of the rules used to predict bacterial attachment to surfaces of non-toxic synthetic materials. Here we outline our view on the state of this field and the challenges and opportunities in this area for the coming years.

Statement of significance

This opinion article on high throughput screening methods reflects one aspect of how the field of biomaterials research has developed and progressed. The piece takes the reader through key developments in biomaterials discovery, particularly focusing on need to reduce bacterial colonisation of surfaces. Such bacterial resistant surfaces are increasingly required in this age of antibiotic resistance. The influence and origin of high-throughput methods are discussed with insights into the future of biomaterials development where computational methods may drive materials development into new fertile areas of discovery.

New biomaterials will exhibit responsiveness to adapt to the biological environment and promote better integration and reduced rejection or infection.

Enhanced cytocompatibility and functional group content of poly(l-lysine) dendrimers by grafting with poly(oxazolines)

We report the use of polyoxazolines as materials for modifying the surface of a generation 5 l-lysine dendrimer resulting in a significant improvement in the biocompatibility properties compared to the unmodified dendrimer. The polyoxazoline coatings represent interesting alternatives to polyethylene glycol and can also offer an opportunity for increasing drug loading.

Thermoresponsive magnetic colloidal gels via surface-initiated polymerisation from functional microparticles

Novel magnetothermally responsive core–shell microparticles have been synthesized.

One-pot RAFT and fast polymersomes assembly: a ‘beeline’ from monomers to drug-loaded nanovectors

A ‘fast RAFT’ strategy that allows the engineering of drug-containing polymer vesicles in only a few hours, starting from functional monomers.

The effects of Park sham needles: a pilot study

BACKGROUND

When performing clinical trials involving acupuncture, it can be difficult to choose a placebo control.

OBJECTIVE

To validate the Park sham needle for use as a double-blind control intervention.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS

Two different methods were employed. First, a researcher blinded to needle type administered the Park sham or a real needle, chosen at random, on the arms of 16 healthy volunteers. The researcher and the volunteers independently recorded which needle type they thought had been applied at each acupuncture point. Second, 19 patients with shoulder impingement syndrome were randomly assigned to receive acupuncture applied with the real needle or the Park sham needle, once a week for 6 weeks alongside a course of physiotherapy. At the end of the 6 sessions the patients recorded which needle type they thought was being used. The results were analyzed with a Fisher's exact test. This study was carried out in the Outpatient Department of Physiotherapy in Charing Cross Hospital, London, UK, on healthy volunteers and patients with shoulder impingement pain. The age range was 23 to 54 and 22 to 74 years respectively.

RESULTS

Of the healthy volunteers, there was no difference (P=0.23) between the number of needles that were correctly (n=43) or incorrectly identified (n=53). All patients thought that they had received the real needles. The researcher correctly identified all needles that were applied.

CONCLUSION

The researcher delivering the acupuncture recognized the needle type. However, both healthy and patient volunteers were blind to the needle type. This demonstrates that the Park sham needle is an effective single-blind control. It should be noted that the number of patients recruited was small and the study was underpowered to detect an effect of treatment.