Search results
Found 22885 matches for
Allied health professionals’ research capacity: open to interpretation?
AbstractAllied health professional research capacity and culture has been the focus of growing research interest of late. The recent study by Comer et al. represents the largest survey of allied health research capacity and culture to date. We congratulate the authors on this work and would like to raise some discussion points in relation to their study.The authors have interpreted their research capacity and culture survey results using cut-off values to indicate a degree of adequacy in relation to perceived research success and/or skill level. To our knowledge, the constructs of the research capacity and culture tool have not been validated to an extent that would enable such an inference to be made.Comer et al. describe perceived individual research success and/or skill as adequate, but the rating of skills in areas necessary for the conduct of original research, such as writing research protocols, ethics submissions, securing funding, and writing for publication range from median scores one to three, which is considered ‘less than adequate’ on the interpretation scale used by the authors.The survey results for the individual and organisational domains reported in Comer et al. are comparable to other similar studies. However, they uniquely conclude research success and/or skill to be adequate in both domains, which is contrary to the interpretation of the other studies.The interpretation of allied health professional research success and skill offered by Cromer et al. differs from studies with similar results and is contrary to previous reports of insufficient research capacity in terms of research trained and active practitioners within these professions in the UK.
Musculoskeletal health state and physical function of intensive care unit survivors: protocol for a UK multicentre prospective cohort study (the MSK-ICU study)
IntroductionSurvivors of critical illness frequently experience long-term physical impairment, decreased health-related quality of life and low rates of return to employment. There has been limited investigation of the underlying problems affecting physical function post-intensive care unit (ICU) admission. Musculoskeletal (MSK) conditions may be complex in presentation, with ICU survivors potentially at greater risk of their development due to the rapid muscle mass loss seen in ICU. The MSK health state of ICU survivors and its impact on physical function remain largely unknown. The aim of the MSK-ICU study is to determine and characterise the MSK health state of ICU survivors 6 months following admission to ICU, in order to inform development of targeted rehabilitation interventions.Methods and analysisThe MSK-ICU study is a multicentre prospective longitudinal cohort study, evaluating the MSK health state of ICU survivors 6 months after admission to ICU. The study consists of a primary study and two substudies. The primary study will be a telephone follow-up of adults admitted to ICU for more than 48 hours, collecting data on MSK health state, quality of life, employment, anxiety and depression and symptoms of post-traumatic stress disorder. The planned sample size is 334 participants. Multivariable regression will be used to identify prognostic factors for a worse MSK health state, as measured by the MSK-Health Questionnaire. In substudy 1, participants who self-report any MSK problem will undergo a detailed, in-person MSK physical assessment of pain, peripheral joint range of movement and strength. In substudy 2, participants reporting a severe MSK problem will undergo a detailed physical assessment of mobility, function and muscle architecture.Ethics and disseminationEthical approval has been obtained through the North of Scotland Research Ethics Committee 2 (21/NS/0143). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media.Trial registration numberISRCTN24998809.
Exploring research capacity and culture of allied health professionals: a mixed methods evaluation
Abstract Background Despite the myriad benefits of research to patients, professionals, and organisations, fewer than 0.1% of the Allied Health Professions workforce are employed in clinical academic roles. Identified barriers include a lack of role modelling, management support, funding, and availability of clinical academic roles. Research capacity building is critical to improving Allied Health Professional research capability. The aim of this evaluation was to explore the current research capacity and culture of Allied Health Professionals to inform future tailored research capacity building strategies at a local level. Methods A mixed methods evaluation of research capacity and culture was conducted within the Allied Health Professions department of a large National Health Service Foundation Trust using an online research capacity and culture questionnaire, followed by focus groups. Staff were recruited using a purposive method with the questionnaire and subsequent focus groups completed between July and September 2020. Data from the questionnaire was analysed using simple descriptive statistics and after inductive coding, focus group data was analysed thematically. Results 93 out of 278 staff completed the questionnaire and 60 staff members attended seven focus groups. The research capacity and culture survey reported the department’s key strength as promoting clinical practice based on evidence (median=8, range=6-9). A key reported weakness of the department was insufficient resources to support staff research training (med=4, 3-6). Respondents considered themselves most skilled in finding relevant literature (med=6, 5-8) and least skilled at securing research funding (med=1, 1-2). Greater than half of the respondents (n=50) reported not currently being involved with research. Five themes were identified from the focus groups: empowerment; building research infrastructure; fostering research skills; access for all; and positive research culture. Conclusions Allied Health Professionals recognise the benefits of research at teams and departmental level, but marginally at an individual level. Local research capacity building strategies should aim to address the role, responsibilities and barriers to Allied Health Profession research development at an individual level. To ensure all staff can engage, research infrastructure and empowerment are essential.
Early-Onset Cone Photoreceptor Degeneration Is Associated With High Myopia in RPGR-Related Retinal Dystrophy.
Purpose: High myopia is a feature of several inherited retinal diseases, including X-linked retinitis pigmentosa (XLRP) which is characterized by childhood onset, centripetal photoreceptor degeneration, and rapid progression to blindness by the fourth decade. Mutations in the retinitis pigmentosa GTPase regulator (RPGR) gene cause over 90% of XLRP cases. It presents with a varied clinical phenotype, categorized into the predominant rod-cone, cone-rod, and cone dystrophy. This case-series study examines the clinical characteristics of patients with RPGR-related retinal dystrophy to identify associations with refractive error. Methods: Data collected between October 2023 and April 2024 from retinal imaging, clinical ophthalmic examination, and genetic analysis were retrospectively analyzed. Results: Twenty-four male patients were identified, with a mean age of 30 years (range 7-57). The median (IQR) best-corrected visual acuity was 60 (55-66) letters in the cone-rod/cone phenotype and 65 (49-73) letters in the rod-cone phenotype. High axial myopia showed preponderance in cone-dominated degenerations. Estimated mean refractive error was -7.92DS (95% CI: [-11.39, -4.44]) in the cone-rod phenotype and -3.52DS (95% CI: [-5.87, -1.17]) in the rod-cone phenotype, adjusting for age and genetic mutation. This difference between phenotype was significant (p=0.041). In a subanalysis, no significant association was found between refractive error and nucleotide position. Evaluation of disease progression found that all patients with a fast-progressing, rod-cone phenotype had high myopia. Conversely, one patient who presented with a slow-progressing, cone-rod phenotype did not have high myopia. Conclusions: Refractive trends in this cohort suggest that cone photoreceptor degeneration occurring during early childhood is associated with high myopia. Image degradation primarily due to cone photoreceptor dysfunction may act as a stimulus to drive myopia development in early childhood. These observations advocate for the earlier treatment of myopia in cone-dominated RPGR-related retinal dystrophy to preserve retinal function and minimize the risks of retinal gene therapy surgery for patients enrolling in clinical trials. Trial Registration: ClinicalTrials.gov identifier: NCT03116113.
A cognitive map for value-guided choice in the ventromedial prefrontal cortex.
The prefrontal cortex (PFC) is crucial for economic decision-making. However, how PFC value representations facilitate flexible decisions remains unknown. We reframe economic decision-making as a navigation process through a cognitive map of choice values. We found rhesus macaques represented choices as navigation trajectories in a value space using a grid-like code. This occurred in ventromedial PFC (vmPFC) local field potential theta frequency across two datasets. vmPFC neurons deployed the same grid-like code and encoded chosen value. However, both signals depended on theta phase: occurring on theta troughs but on separate theta cycles. Finally, we found sharp-wave ripples-a key signature of planning and flexible behavior-in vmPFC. Thus, vmPFC utilizes cognitive map-based computations to organize and compare values, suggesting an alternative architecture for economic choice in PFC.
Neural mechanisms of credit assignment for delayed outcomes during contingent learning.
Adaptive behavior in complex environments critically relies on the ability to appropriately link specific choices or actions to their outcomes. However, the neural mechanisms that support the ability to credit only those past choices believed to have caused the observed outcomes remain unclear. Here, we leverage multivariate pattern analyses of functional magnetic resonance imaging (fMRI) data and an adaptive learning task to shed light on the underlying neural mechanisms of such specific credit assignment. We find that the lateral orbitofrontal cortex (lOFC) and hippocampus (HC) code for the causal choice identity when credit needs to be assigned for choices that are separated from outcomes by a long delay, even when this delayed transition is punctuated by interim decisions. Further, we show when interim decisions must be made, learning is additionally supported by lateral frontopolar cortex (lFPC). Our results indicate that lFPC holds previous causal choices in a 'pending' state until a relevant outcome is observed, and the fidelity of these representations predicts the fidelity of subsequent causal choice representations in lOFC and HC during credit assignment. Together, these results highlight the importance of the timely reinstatement of specific causes in lOFC and HC in learning choice-outcome relationships when delays and choices intervene, a critical component of real-world learning and decision making.
A tale of two algorithms: Structured slots explain prefrontal sequence memory and are unified with hippocampal cognitive maps.
Remembering events is crucial to intelligent behavior. Flexible memory retrieval requires a cognitive map and is supported by two key brain systems: hippocampal episodic memory (EM) and prefrontal working memory (WM). Although an understanding of EM is emerging, little is understood of WM beyond simple memory retrieval. We develop a mathematical theory relating the algorithms and representations of EM and WM by unveiling a duality between storing memories in synapses versus neural activity. This results in a formalism of prefrontal WM as structured, controllable neural subspaces (activity slots) representing dynamic cognitive maps without synaptic plasticity. Using neural networks, we elucidate differences, similarities, and trade-offs between the hippocampal and prefrontal algorithms. Lastly, we show that prefrontal representations in tasks from list learning to cue-dependent recall are unified as controllable activity slots. Our results unify frontal and temporal representations of memory and offer a new understanding for dynamic prefrontal representations of WM.
An Analysis of Scotopic Microperimetry in Healthy Adults.
PurposeScotopic microperimetry measures retinal sensitivity under very low light and may be useful in conditions characterized by nyctalopia, such as retinitis pigmentosa and age-related macular degeneration. The Scotopic Macular Integrity Assessment device enables two-color perimetry to isolate rod and cone responses. This study assesses the reliability, test-retest repeatability, and sensitivity in healthy participants aiming to establish normative values.MethodsScotopic microperimetry was performed using cyan and red stimuli on a 37-point radial grid after dark adaptation on control participants with no history of eye disease and visual acuity of 0.1 logarithm of the minimum angle of resolution or better. Fixation stability, fixation losses, and identification of the rod-free zone were used as reliability metrics. A subset underwent repeat testing within 4 weeks.ResultsThirty-nine participants (19 male and 20 female), median age 24 years (interquartile range, 9.5 years) and 23 years (interquartile range, 9 years) for the right and left eyes, respectively, completed testing. Overall 77 eyes underwent scotopic testing, with 82% meeting reliability criteria. Mean cyan and red sensitivities were 19.9 ± 1.1 dB and 20.9 ± 1.2 dB in right eyes, and 20.1 ± 1.4 dB and 21.3 ± 1.4 dB in left eyes, respectively. Volumetric cyan and red sensitivities were 2868 ± 157 dB.deg2 and 3077 ± 176 dB.deg2 in the right eyes, respectively, and 2892 ± 205 dB.deg2 and 3126 ± 207 dB.deg2 in the left eyes, respectively. Mean sensitivity coefficients of repeatability (CoR) were ± 1.4 dB (cyan) and ± 2.1 dB (red) while pointwise coefficients of repeatability were ± 7.2 dB (95% confidence interval, 6.5-7.6 dB) for cyan and ± 7.9 dB (95% confidence interval, 7.3-8.4 dB) for red, with no significant differences between eyes or genders. Fixation stability assessed using the 95% bivariate contour ellipse area for cyan was 2.9 ± 5.9 deg2 and 2.3 ± 2.2 deg2 for the right and left eyes, respectively, and for red were 0.7 ± 0.6 deg2 and 0.9 ± 0.8 deg2 for the right and left eyes, respectively. Again, there were no significant differences between cyan and red tests (Friedman test, bivariate contour ellipse area 63%, P = 0.455; bivariate contour ellipse area 95%, P = 0.432).ConclusionsScotopic microperimetry using the Scotopic Macular Integrity Assessment device was feasible and well-tolerated. Repeatability metrics demonstrated limitations in fine spatial mapping of scotopic retinal sensitivity.Translational relevanceThis study highlights potential areas for future improvements in scotopic microperimetry before its use as an outcome measure in clinical trials for retinal disease.
Constructing future behavior in the hippocampal formation through composition and replay.
The hippocampus is critical for memory, imagination and constructive reasoning. Recent models have suggested that its neuronal responses can be well explained by state spaces that model the transitions between experiences. Here we use simulations and hippocampal recordings to reconcile these views. We show that if state spaces are constructed compositionally from existing building blocks, or primitives, hippocampal responses can be interpreted as compositional memories, binding these primitives together. Critically, this enables agents to behave optimally in new environments with no new learning, inferring behavior directly from the composition. We predict a role for hippocampal replay in building and consolidating these compositional memories. We test these predictions in two datasets by showing that replay events from newly discovered landmarks induce and strengthen new remote firing fields. When the landmark is moved, replay builds a new firing field at the same vector to the new location. Together, these findings provide a framework for reasoning about compositional memories and demonstrate that such memories are formed in hippocampal replay.
Exploring standard and low luminance visual acuity and the Moorfields Acuity Chart as outcome measures in inherited retinal disease
AbstractIntroductionStandard visual acuity (VA) is often insensitive to subtle changes in vision that result from inherited retinal disease. Low luminance VA (LLVA) has grown in popularity as an alternative acuity measure. A new test, the Moorfields Acuity Chart (MAC) has been designed as a more sensitive and repeatable test for use in patients with age‐related macular degeneration. The study explores the utility and repeatability of standard VA, LLVA and the MAC in a mixed cohort of patients with inherited retinal disease.MethodsParticipants were recruited as part of the visual function in retinal degeneration study (Ethics Reference 20/WM/0283). Standard VA was obtained using the Early Treatment of Diabetic Retinopathy study (ETDRS) chart placed at 4 m. LLVA was obtained using the same ETDRS chart with the addition of a 2.0‐log unit neutral density filter. MAC VA was obtained using standard clinic room lighting. All participants completed repeated testing.ResultsThirty‐five patient participants and 36 healthy controls, with logMAR 1.00 (6/60) or better, completed testing. Both LLVA and MAC VA were reduced compared to standard VA in patient participants and healthy controls (linear mixed model: p < 0.001). All three acuity tests show comparable sensitivity, specificity and repeatability. A subset of participants (patient participants n = 34, healthy controls n = 35) completed microperimetry. Post hoc analysis of microperimetry volume sensitivity correlated significantly with all of the acuity tests and showed no significant difference in the gradient of the slopes. This suggests that VA, LLVA and MAC VA decline at a consistent rate with disease progression.ConclusionAll three acuity tests could be considered viable outcome measures for clinical trials. For patients with early to moderate inherited retinal disease (logMAR 1.00 (6/60) or better), no single acuity chart appeared significantly beneficial.