A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial.

Background: increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause on going disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods: the intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. Results: the final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. Conclusions: the MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.

Pillars and Elements to Develop an Open Business Model for Innovation Networks

Part 9: Innovation Networks

New search for the Neutron Electric Dipole Moment using ultracold neutrons at the Spallation Neutron Source

This document introduces the planned new search for the neutron Electric Dipole Moment at the Spallation Neutron Source at the Oak Ridge National Laboratory. A spin precession measurement is to be carried out using Ultracold neutrons diluted in a superfluid Helium bath at T = 0.5 K, where spin polarized 3He atoms act as detector of the neutron spin polarization. This manuscript describes some of the key aspects of the planned experiment with the contributions from Caltech to the development of the project.

Techniques used in the design of magnet coils for Nuclear Magnetic Resonance were adapted to the geometry of the experiment. Described is an initial design approach using a pair of coils tuned to shield outer conductive elements from resistive heat loads, while inducing an oscillating field in the measurement volume. A small prototype was constructed to test the model of the field at room temperature.

A large scale test of the high voltage system was carried out in a collaborative effort at the Los Alamos National Laboratory. The application and amplification of high voltage to polished steel electrodes immersed in a superfluid Helium bath was studied, as well as the electrical breakdown properties of the electrodes at low temperatures. A suite of Monte Carlo simulation software tools to model the interaction of neutrons, 3He atoms, and their spins with the experimental magnetic and electric fields was developed and implemented to further the study of expected systematic effects of the measurement, with particular focus on the false Electric Dipole Moment induced by a Geometric Phase akin to Berry’s phase.

An analysis framework was developed and implemented using unbinned likelihood to fit the time modulated signal expected from the measurement data. A collaborative Monte Carlo data set was used to test the analysis methods.

Key Participants Of The Tumor Microenvironment Of The Prostate: An Approach Of The Structural Dynamic Of Cellular Elements And Extracellular Matrix Components During Epithelial-stromal Transition.

Cancer is a multistep process that begins with the transformation of normal epithelial cells and continues with tumor growth, stromal invasion and metastasis. The remodeling of the peritumoral environment is decisive for the onset of tumor invasiveness. This event is dependent on epithelial-stromal interactions, degradation of extracellular matrix components and reorganization of fibrillar components. Our research group has studied in a new proposed rodent model the participation of cellular and molecular components in the prostate microenvironment that contributes to cancer progression. Our group adopted the gerbil Meriones unguiculatus as an alternative experimental model for prostate cancer study. This model has presented significant responses to hormonal treatments and to development of spontaneous and induced neoplasias. The data obtained indicate reorganization of type I collagen fibers and reticular fibers, synthesis of new components such as tenascin and proteoglycans, degradation of basement membrane components and elastic fibers and increased expression of metalloproteinases. Fibroblasts that border the region, apparently participate in the stromal reaction. The roles of each of these events, as well as some signaling molecules, participants of neoplastic progression and factors that promote genetic reprogramming during epithelial-stromal transition are also discussed.