Improving participation outcomes and interventions in neurodisability: co-designing future research

There is an urgent, agreed need to improve participation outcomes and interventions for children and young people with neurodisability. We worked together with service users and providers to design research into participation outcomes and interventions in neurodisability. We built on existing evidence about participation outcomes and interventions and the WHO International Classification of Functioning, Disability and Health. We: (1) specified seven participation outcome categories for measurement; (2) prioritized these for improvement: self-care, friends and social, and physical activity ranked the highest; (3) identified 11 potential intervention categories for targeting the top priority, self-care, through eight hypothesized change mechanisms and agreed for the interventions to be delivered as a 'Menu of Interventions' for personalized self-care support; and (4) designed a before-and-after mixed methods feasibility study to evaluate the Menu with children and young people (0-12 years) and their parents and therapists.

The Management and Rehabilitation of the Stroke Patient

The residual neurological deficits after stroke are discussed in this article. The main problems are weakness, spasticity and rigidity. Weakness may be amenable to help with a variety of physical aids and mobility maintained with a wheelchair. Spasticity is defined in terms of the neurological defect and its consequences examined in the clinical context of the stroke patient. The place of antispastic drugs and their method of use is described. The importance of sensory loss in the production of functional disability is also discussed.

Heel pressures with generic and focused rigid heel cast devices while in a static supine and seated position

Objective:

To identify if the choice of material used to make focused rigid cast (FRC) and generic heel cups has an effect on heel pressure in healthy individuals during a static supine and seated position.

Method:

A repeated measure design was used to compare the effect of two focused rigidity heel devices made from different materials (3M semi-rigid and Benecast FLEX) and a generic polymer gel heel cup device on barefoot heel pressures. Subjects had heel pressures taken while barefoot and with the three different heel devices while in a supine and seated position using the device.

Results:

We recruited 32 healthy participants (21 females, and 11 males). When comparing Benecast FLEX and 3M semi-rigid focused rigidity casts with barefoot and the generic heel cups significant reductions in pressures were seen in all areas while seated and in the distal area while supine. However, there was no statistical difference between the two FRC devices, or between barefoot and the generic heel cup in either position.

Conclusion:

This study demonstrates that FRC heel devices effectively reduced heel pressures in healthy individuals and therefore could be used in practice when a reduction in pressure is required for the management of heel pressure ulcers in bedbound or chair-bound patients.

Declaration of interest:

Materials were supplied from Benecare Medical (who agreed to supply 20 rolls of Benecast FLEX), and the podiatry department of Kent Community Health NHS Trust (who agreed to supply some of the materials).

The fibronectin/α3β1 integrin axis serves as molecular basis for keratinocyte invasion induced by βHPV

Organ-transplant-recipients exhibit cancerization of the skin from which multiple human papillomavirus (HPV)-positive squamous cell carcinomas (SCCs) arise. However, the molecular basis for HPV-induced invasion of skin keratinocytes is not known. We generated a transgenic mouse model expressing the E7 oncoprotein of HPV8 in the murine epidermis under the control of the keratin-14 promoter and showed that E7 is carcinogenic in mice. We further showed that both, the E7-expressing keratinocyte and mesenchymal components of the extracellular matrix as critical in eliciting the invasive behavior. E7 expression in basal keratinocytes, grown on fibronectin, led to epithelial-mesenchymal transition mediated by a cadherin switch. E7-positive keratinocytes displayed enhanced EDA-fibronectin expression and secretion and stimulated dermal fibroblasts to express EDA-fibronectin. Deposition of fibronectin was also detected in the peritumoral stroma of HPV8-positive skin SCC. When grown on fibronectin, E7-positive keratinocytes, in particular stem cell-like cells, exhibited increased cell surface levels of the α3-integrin chain. Functional blocking confirmed α3 as a critical molecule sufficient to induce E7-mediated invasion. This mechanistic link is further supported by expression of an E7-mutant, impaired in targeting α3 to the cell surface. These findings highlight the importance of epithelial-extracellular matrix interaction required for keratinocyte invasion and provide further mechanistic evidence for a role of HPV in skin carcinogenesis.

Modeling the evolution space of breakage fusion bridge cycles with a stochastic folding process

Breakage-fusion-bridge cycles in cancer arise when a broken segment of DNA is duplicated and an end from each copy joined together. This structure then 'unfolds' into a new piece of palindromic DNA. This is one mechanism responsible for the localised amplicons observed in cancer genome data. Here we study the evolution space of breakage-fusion-bridge structures in detail. We firstly consider discrete representations of this space with 2-d trees to demonstrate that there are [Formula: see text] qualitatively distinct evolutions involving [Formula: see text] breakage-fusion-bridge cycles. Secondly we consider the stochastic nature of the process to show these evolutions are not equally likely, and also describe how amplicons become localized. Finally we highlight these methods by inferring the evolution of breakage-fusion-bridge cycles with data from primary tissue cancer samples.