PASSCLAIM - gut health and immunity

Background The gut and immune system form a complex integrated structure that has evolved to provide effective digestion and defence against ingested toxins and pathogenic bacteria. However, great variation exists in what is considered normal healthy gut and immune function. Thus, whilst it is possible to measure many aspects of digestion and immunity, it is more difficult to interpret the benefits to individuals of variation within what is considered to be a normal range. Nevertheless, it is important to set standards for optimal function for use both by the consumer, industry and those concerned with the public health. The digestive tract is most frequently the object of functional and health claims and a large market already exists for gut-functional foods worldwide. Aim To define normal function of the gut and immune system and describe available methods of measuring it. Results We have defined normal bowel habit and transit time, identified their role as risk factors for disease and how they may be measured. Similarly, we have tried to define what is a healthy gut flora in terms of the dominant genera and their metabolism and listed the many, varied and novel methods for determining these parameters. It has proved less easy to provide boundaries for what constitutes optimal or improved gastric emptying, gut motility, nutrient and water absorption and the function of organs such as the liver, gallbladder and pancreas. The many tests of these functions are described. We have discussed gastrointestinal well being. Sensations arising from the gut can be both pleasant and unpleasant. However, the characteristics of well being are ill defined and merge imperceptibly from acceptable to unacceptable, a state that is subjective. Nevertheless, we feel this is an important area for future work and method development. The immune system is even more difficult to make quantitative judgements about. When it is defective, then clinical problems ensure, but this is an uncommon state. The innate and adaptive immune systems work synergistically together and comprise many cellular and humoral factors. The adaptive system is extremely sophisticated and between the two arms of immunity there is great redundancy, which provides robust defences. New aspects of immune function are discovered regularly. It is not clear whether immune function can be "improved". Measuring aspects of immune function is possible but there is no one test that will define either the status or functional capacity of the immune system. Human studies are often limited by the ability to sample only blood or secretions such as saliva but it should be remembered that only 2% of lymphocytes circulate at any given time, which limits interpretation of data. We recommend assessing the functional capacity of the immune system by: measuring specific cell functions ex vivo, measuring in vivo responses to challenge, e. g. change in antibody in blood or response to antigens, determining the incidence and severity of infection in target populations during naturally occurring episodes or in response to attenuated pathogens.

The Ca(v)2.3 calcium channel antagonist SNX-482 reduces dorsal horn neuronal responses in a rat model of chronic neuropathic pain

Neuropathic pain is a difficult state to treat, characterized by alterations in sensory processing that can include allodynia (touch-evoked pain). Evidence exists for nerve damage-induced plasticity in both transmission and modulatory systems, including changes in voltage-dependent calcium channel (VDCC) expression and function; however, the role of Ca(v)2.3 calcium channels has not clearly been defined. Here, the effects of SNX-482, a selective Ca(v)2.3 antagonist, on sensory transmission at the spinal cord level have been investigated in the rat. The spinal nerve ligation (SNL) model of chronic neuropathic pain [Kim & Chung, (1992) Pain, 50, 355-363] was used to induce mechanical allodynia, as tested on the ipsilateral hindpaw. In vivo electrophysiological measurements of dorsal horn neuronal responses to innocuous and noxious electrical and natural stimuli were made after SNL and compared to sham-operated animals. Spinal SNX-482 (0.5-4 mu g/50 mu L) exerted dose-related inhibitions of noxious C-fibre- and A delta-fibre-mediated neuronal responses in conditions of neuropathy, but not in sham-operated animals. Measures of spinal cord hyperexcitability and nociception were most susceptible to SNX-482. In contrast, non-noxious A beta-mediated responses were not affected by SNX-482. Moreover, responses to innocuous mechanical and also thermal stimuli were more sensitive to SNX-482 in SNL than control animals. This study is the first to demonstrate an antinociceptive role for SNX-482-sensitive channels in dorsal horn neurons during neuropathy. These data are consistent with plasticity in Ca(V)2.3 calcium channel expression and suggest a potential selective target to reduce nociceptive transmission during conditions of nerve damage.

Is NHS Direct meeting the needs of mental health callers?

Background: NHS Direct is a new service that offers 24-hour advice from trained nurses. The National Service Framework for Mental Health and the National Strategy for Carers both mention NHS Direct as an important source of support for people with mental health problems. Aims: This paper reports findings from an evaluation of the Department of Health's NHS Direct mental health initiative. This initiative was established to ensure that NHS Direct can meet the needs of callers with mental health problems by offering additional training to all staff and improving the database of mental health services. Method: The findings reported here are based on routine computer data provided by 12 out of 17 NHS Direct sites, 552 data forms completed by nurse advisers from the 17 sites, and 111 questionnaires administered over the telephone with callers to the 17 sites. Results: Mental health calls accounted for 3% of NHS Direct's workload, although these calls were often longer and more complex than other calls. The majority of callers to the service were in touch with other services for their mental health problems (59%), typically their GP. Most callers had 'moderate' mental health problems, as indicated by the Global Assessment of Functioning Scale. Generally callers were satisfied with the service they received, although satisfaction was lower in some areas than previous studies of NHS Direct. Conclusions: Improvements could be made in the mechanisms for referring callers on to other services, and training to increase nurse advisers' knowledge of mental health problems.

Health informatics: improving patient-centred healthcare pathway

Nowadays the use of information and communication technology is becoming prevalent in many aspects of healthcare services from patient registration, to consultation, treatment and pathology tests request. Manual interface techniques have dominated data-capture activities in primary care and secondary care settings for decades. Despites the improvements made in IT, usability issues still remain over the use of I/O devices like the computer keyboard, touch-sensitive screens, light pen and barcodes. Furthermore, clinicians have to use several computer applications when providing healthcare services to patients. One of the problems faced by medical professionals is the lack of data integrity between the different software applications which in turn can hinder the provision of healthcare services tailored to the needs of the patients. The use of digital pen and paper technology integrated with legacy medical systems hold the promise of improving healthcare quality. This paper discusses the issue of data integrity in e-health systems and proposes the modelling of "Smart Forms" via semiotics to potentially improve integrity between legacy systems, making the work of medical professionals easier and improve the quality of care in primary care practices and hospitals.

Issues impairing the success of neural implant technology

By monitoring signals from the central nervous system, humans can be provided with a novel extra channel of communication that can, for example, be used for the voluntary control of peripheral devices. Meanwhile, stimulation of neural tissue can bring about sensation such as touch, can facilitate feedback from external, potentially remote devices and even opens up the possibility of new sensory input for the individual to experience. The concept of successfully harnessing and stimulating nervous system activity is though something that can only be achieved through an appropriate interface. However, interfacing the nervous system by means of implant technology carries with it many problems and dangers. Further, results achieved may not be as expected or as they at first appear. This paper describes a comparative study investigating different implant types and procedures. It is aimed at highlighting potential problem areas and is intended to provide a useful reference explaining important tolerances and limits.

A Lady of York: migration, ethnicity and identity in Roman Britain

Modern methods of analysis applied to cemeteries have often been used in our pages to suggest generalities about mobility and diet. But these same techniques applied to a single individual, together with the grave goods and burial rite, can open a special kind of personal window on the past. Here, the authors of a multidisciplinary project use a combination of scientific techniques to illuminate Roman York, and later Roman history in general, with their image of a glamorous mixed-race woman, in touch with Africa, Christianity, Rome and Yorkshire.

Mechatronic design of a high frequency probe for haptic interaction

Current force feedback, haptic interface devices are generally limited to the display of low frequency, high amplitude spatial data. A typical device consists of a low impedance framework of one or more degrees-of-freedom (dof), allowing a user to explore a pre-defined workspace via an end effector such as a handle, thimble, probe or stylus. The movement of the device is then constrained using high gain positional feedback, thus reducing the apparent dof of the device and conveying the illusion of hard contact to the user. Such devices are, however, limited to a narrow bandwidth of frequencies, typically below 30Hz, and are not well suited to the display of surface properties, such as object texture. This paper details a device to augment an existing force feedback haptic display with a vibrotactile display, thus providing a means of conveying low amplitude, high frequency spatial information of object surface properties. 1. Haptics and Haptic Interfaces Haptics is the study of human touch and interaction with the external environment via touch. Information from the human sense of touch can be classified in to two categories, cutaneous and kinesthetic. Cutaneous information is provided via the mechanoreceptive nerve endings in the glabrous skin of the human hand. It is primarily a means of relaying information regarding small-scale details in the form of skin stretch, compression and vibration.

The brain’s fingers and hands

The brain keeps track of the changing positions of body parts in space using a spatial body schema. When subjects localise a tactile stimulus on the skin, they might either use a somatotopic body map, or use a body schema to identify the location of the stimulation in external space. Healthy subjects were touched on the fingertips, with the hands in one of two postures: either the right hand was vertically above the left, or the fingers of both hands were interwoven. Subjects made speeded verbal responses to identify either the finger or the hand that was touched. Interweaving the fingers significantly impaired hand identification across several experiments, but had no effect on finger identification. Our results suggest that identification of fingers occurs in a somatotopic representation or finger schema. Identification of hands uses a general body schema, and is influenced by external spatial location. This dissociation implies that touches on the finger can only be identified with a particular hand after a process of assigning fingers to hands. This assignment is based on external spatial location. Our results suggest a role of the body schema in the identification of structural body parts from touch.

Advances in upper limb stroke rehabilitation: a technology push

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

Cursor relocation techniques to help older adults find 'lost' cursors

Older adult computer users often lose track of the mouse cursor and so resort to methods such as mouse shaking or searching the screen to find the cursor again. Hence, this paper describes how a standard optical mouse was modified to include a touch sensor, activated by releasing and touching the mouse, which automatically centers the mouse cursor to the screen, potentially making it easier to find a 'lost' cursor. Six older adult computer users and six younger computer users were asked to compare the touch sensitive mouse with cursor centering with two alternative techniques for locating the mouse cursor: manually shaking the mouse and using the Windows sonar facility. The time taken to click on a target following a distractor task was recorded, and results show that centering the mouse was the fastest to use, with a 35% improvement over shaking the mouse. Five out of six older participants ranked the touch sensitive mouse with cursor centering as the easiest to use.

Transition of pupils from Key Stage 2 to 3 deemed gifted and talented in mathematics: an initial study

In this article Geoff Tennant and Dave Harries report on the early stages of a research project looking to examine the transition from Key Stage (KS) 2 to 3 of children deemed Gifted and Talented (G&T) in mathematics. An examination of relevant literature points towards variation in definition of key terms and underlying rationale for activities. Preliminary fieldwork points towards a lack of meaningful communication between schools, with primary school teachers in particular left to themselves to decide how to work with children deemed G&T. Some pointers for action are given, along with ideas for future research and a request for colleagues interested in working with us to get in touch.

Gravity well visibility in haptic interfaces for motion-impaired

Haptic computer interfaces provide users with feedback through the sense of touch, thereby allowing users to feel a graphical user interface. Force feedback gravity wells, i.e. attractive basins that can pull the cursor toward a target, are one type of haptic effect that have been shown to provide improvements in "point and click" tasks. For motion-impaired users, gravity wells could improve times by as much as 50%. It has been reported that the presentation of information to multiple sensory modalities, e.g. haptics and vision, can provide performance benefits. However, previous studies investigating the use of force feedback gravity wells have generally not provided visual representations of the haptic effect. Where force fields extend beyond clickable targets, the addition of visual cues may affect performance. This paper investigates how the performance of motion-impaired computer users is affected by having visual representations of force feedback gravity wells presented on-screen. Results indicate that the visual representation does not affect times and errors in a "point and click" task involving multiple targets.

Urban planning under Major: the end of Thatcherism?

This paper explores the urban planning legacy left by Mrs Thatcher. To what extent has Mr Major continued with her approach? Has he developed new directions? This broad question provides the background for an examination of the changes to the planning system since Mrs Thatcher left office. The main themes covered are the new plan-led emphasis, the increase in the coverage of environmental issues, the question of whether a more people oriented perspective has developed with Major's softer touch and the Citizen's Charter and the property-led approach to urban regeneration. The paper concludes that although the contradictions of Thatcherism have led to the relaxation of certain ideological stances to planning, the central themes of Thatcherism - individualism and centralisation - continue unabated.