Search

— This research investigates the potential of contactless finger motion measurement, focusing particularly on ease of use to improve the success of home-based hand rehabilitation exercises. Previously, a mathematical model was developed based on a finite element method (FEM) simulation. This paper validates this model on multi-finger noncontact measuring under laboratory conditions. Twenty-three healthy subjects with normal hand and finger functions participated. An independent near field distance measurement was developed and compared to the output from an optical sensor. It was observed from the experiment that the prediction model worked well with the measuring system reported here. The average uncertainties of measurement using the prediction model are 0.68mm and 0.55mm, which are 3.5% and 2.7% of the full-scale range, for index finger and middle finger respectively. The results from the experiment show that, the reported system is capable of measuring the small movements of fingers. With the combination of the noncontact measuring feature and the lack of complicated set-up, this system is easy-to-use as the basis of a home-based independent rehabilitation system.

Background We report follow-on research from our previous qualitative analysis of how neurologists offer patients choice in practice. This focus reflects the NHS’s emphasis on ‘patient choice’ and the lack of evidence-based guidance on how to enact it. Our primary study identified practices for offering choice, which we called ‘patient view elicitors’ (PVEs) and ‘option-listing’. However, that study was not designed to compare these with recommendations or to analyse the consequences of selecting one practice over another. Objectives To (1) map out (a) the three decision-making practices – recommending, PVEs and option-listing – together with (b) their interactional consequences; (2) identify, qualitatively and quantitatively, interactional patterns across our data set; (3) statistically examine the relationship between interactional practices and self-report data; and (4) use the findings from 1–3 to compare the three practices as methods for initiating decision-making. Design A mixed-methods secondary analysis of recorded neurology consultations and associated questionnaire responses. We coded every recommendation, PVE and option-list together with a range of variables internal (e.g. patients’ responses) and external to the consultation (e.g. self-reported patient satisfaction). The resulting matrix captured the qualitative and quantitative data for every decision. Setting and participants The primary study was conducted in two neurology outpatient centres. A total of 14 neurologists, 223 patients and 114 accompanying others participated. Results Distribution of practices – recommending was the most common approach to decision-making. Patient demographics did not appear to play a key role in patterning decisional practices. Several clinical factors did show associations with practice, including (1) that neurologists were more likely to use option-lists or PVEs when making treatment rather than investigation decisions, (2) they were more certain about a diagnosis and (3) symptoms were medically explained. Consequences of practices – option-lists and PVEs (compared with recommendations) – were strongly associated with choice by neurologists and patients. However, there was no significant difference in overall patient satisfaction relating to practices employed. Recommendations were strongly associated with a course of action being agreed. Decisions containing PVEs were more likely to end in rejection. Option-lists often ended in the decision being deferred. There was no relationship between length of consultation and the practice employed. Limitations A main limitation is that we judged only outcomes based on the recorded consultations and the self-report data collected immediately thereafter. We do not know what happened beyond the consultation. Conclusions Patient choice is harder to enact than policy directives acknowledge. Although there is good evidence that neurologists are seeking to enact patient choice, they are still more likely to make recommendations. This appears to be partly due to concerns that ‘choice’ might conflict with doctors’ duty of care. Future guidance needs to draw on evidence regarding choice in practice to support doctors and patients to achieve the wider goal of shared decision-making. Future research To advance understanding of how interactional practices might have effects beyond the clinic, a priority is to investigate associations between decision-making practices and external outcomes (such as adherence). Funding The National Institute for Health Research Health Services and Delivery Research programme.

Home based or tele technological systems and smart devices have provided alternative delivery forms to promote hand rehabilitation. As a step towards the targeted system, a finite element method (FEM) simulation based on MGC3130 three-layer electrode design in Comsol®, and a nonlinear regression analysis using Matlab® were carried out. Concerning different combinations of fingers’ movement and the symmetrical structure of the simulation model, nine cases in total are simulated. In each case, there are ten testing points, ranging from 0mm to 30mm, to explore the inherent relationship between the distance changed from finger motion and the voltage signals detected in the receive electrodes. The results in both the original electrode design and the modified electrodes design agree with the quasi-static electrical near field theory and the symmetrical structure of the three-layer electrodes. Based on the simulation result, the functional relationship of the data was also investigated. The nonlinear equation, describing the performance of the electrode layers, fits well in both electrode designs, which implies a clear inverse relation between the changed distance and the detected voltage signals. The equation also reflects the sensitive and finite features of the design, which helps to guide and optimize the practical design of the electrodes in the future investigations.

Summary CD6 is a transmembrane protein with an extracellular region containing three scavenger receptor cysteine rich (SRCR) domains. The membrane proximal domain of CD6 binds the N-terminal immunoglobulin superfamily (IgSF) domain of another cell surface receptor, CD166, which also engages in homophilic interactions. CD6 expression is mainly restricted to T cells, and the interaction between CD6 and CD166 regulates T-cell activation. We have solved the X-ray crystal structures of the three SRCR domains of CD6 and two N-terminal domains of CD166. This first structure of consecutive SRCR domains reveals a nonlinear organization. We characterized the binding sites on CD6 and CD166 and showed that a SNP in CD6 causes glycosylation that hinders the CD6/CD166 interaction. Native mass spectrometry analysis showed that there is competition between the heterophilic and homophilic interactions. These data give insight into how interactions of consecutive SRCR domains are perturbed by SNPs and potential therapeutic reagents., Graphical Abstract, Highlights • First structure of consecutive scavenger receptor cysteine rich domains in CD6 • Structure of the two N-terminal domains of CD166 which is the ligand for CD6 • Mapping binding sites on CD6 and CD166 • Insight into how CD6 and its interactions are perturbed by polymorphisms and mAbs, Chappell et al. present structures of the T-cell surface receptor, CD6, the first of consecutive scavenger receptor cysteine rich domains and its ligand, CD166. The structures give insight into how CD6 and its interactions are perturbed by competition between homophilic and heterophilic interactions, SNPs, and mAbs.