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Randomised feasibility study of physiotherapy for patients with functional motor symptoms
ObjectiveTo determine the feasibility of conducting a randomised controlled trial of a specialist physiotherapy intervention for functional motor symptoms (FMS).MethodsA randomised feasibility study was conducted recruiting patients with a clinically established diagnosis of FMS from a tertiary neurology clinic in London, UK. Participants were randomised to the intervention or a treatment as usual control. Measures of feasibility and clinical outcome were collected and assessed at 6 months.Results60 individuals were recruited over a 9-month period. Three withdrew, leaving 29 intervention and 28 controls participants in the final analysis. 32% of patients with FMS met the inclusion criteria, of which 90% enrolled. Acceptability of the intervention was high and there were no adverse events. At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group. There was a moderate to large treatment effect across a range of outcomes, including three of eight Short Form 36 (SF36) domains (d=0.46–0.79). The SF36 Physical function was found to be a suitable primary outcome measure for a future trial; adjusted mean difference 19.8 (95% CI 10.2 to 29.5). The additional quality adjusted life years (QALY) with intervention was 0.08 (95% CI 0.03 to 0.13), the mean incremental cost per QALY gained was £12 087.ConclusionsThis feasibility study demonstrated high rates of recruitment, retention and acceptability. Clinical effect size was moderate to large with high probability of being cost-effective. A randomised controlled trial is needed.Trial registration numberNCT02275000; Results.
Journal Article
Grid converters for photovoltaic and wind power systems
Advancements in grid converter technology have been pivotal in the successful integration of renewable energy. The high penetration of renewable energy systems is calling for new more stringent grid requirements. As a consequence, the grid converters should be able to exhibit advanced functions like: dynamic control of active and reactive current injection during faults, and grid services support. <p>This book explains the topologies, modulation and control of grid converters for both photovoltaic and wind power applications. In addition to power electronics, coverage focuses on the specific applications in photovoltaic and wind power systems where grid condition is an essential factor.</p> <p>With a review of the most recent grid requirements for photovoltaic and wind power systems, the relevant issues are discussed:</p> <ul> <li> <div>Modern grid inverter topologies for photovoltaic and wind turbines</div> </li> <li> <div>Islanding detection methods for photovoltaic systems</div> </li> <li> <div>Synchronization techniques based on second order generalized integrators (SOGI)</div> </li> <li> <div>Advanced synchronization techniques with robust operation under grid unbalance condition</div> </li> <li> <div>Resonant controller techniques for current control and harmonic compensation</div> </li> <li> <div>Grid filter design and active damping techniques</div> </li> <li> <div>Power control under grid fault conditions, considering both positive and negative sequences</div> </li> </ul> <p>Throughout, the authors include practical examples, exercises, and simulation models and an accompanying website sets out further modeling techniques using MATLAB® and Simulink environments and physical security information management (PSIM) software.</p> <p><i>Grid Converters for Photovoltaic and Wind Power Systems</i> is intended as a course book for graduate students with a background in electrical engineering and for professionals in the evolving renewable energy industry. For professors interested in adopting the course, a set of slides is available for download from the website.</p> <p><b>Companion Website</b></p> <p><a href=\"http://www.wiley.com/go/grid_converters\">www.wiley.com/go/grid_converters</a></p>
eBook
Becoming Christian: Race, Reformation, and Early Modern English Romance
Becoming Christian argues that romance narratives of Jews and Muslims converting to Christianity register theological formations of race in post-Reformation England. The medieval motif of infidel conversion came under scrutiny as Protestant theology radically reconfigured how individuals acquire religious identities. Whereas Catholicism had asserted that Christian identity begins with baptism, numerous theologians in the Church of England denied the necessity of baptism and instead treated Christian identity as a racial characteristic passed from parents to their children. The church thereby developed a theology that both transformed a nation into a Christian race and created skepticism about the possibility of conversion. Race became a matter of salvation and damnation. Britton intervenes in critical debates about the intersections of race and religion, as well as in discussions of the social implications of romance. Examining English translations of Calvin, treatises on the sacraments, catechisms, and sermons alongside works by Edmund Spenser, John Harrington, William Shakespeare, John Fletcher, and Phillip Massinger, Becoming Christian demonstrates how a theology of race altered a nation's imagination and literary landscape.
eBook
COgnitive behavioural therapy vs standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES): a multicentre randomised controlled trial protocol
Background
The evidence base for the effectiveness of psychological interventions for patients with dissociative non-epileptic seizures (DS) is currently extremely limited, although data from two small pilot randomised controlled trials (RCTs), including from our group, suggest that Cognitive Behavioural Therapy (CBT) may be effective in reducing DS occurrence and may improve aspects of psychological status and psychosocial functioning.
Methods/Design
The study is a multicentre, pragmatic parallel group RCT to evaluate the clinical and cost-effectiveness of specifically-tailored CBT plus standardised medical care (SMC) vs SMC alone in reducing DS frequency and improving psychological and health-related outcomes. In the initial screening phase, patients with DS will receive their diagnosis from a neurologist/epilepsy specialist. If patients are eligible and interested following the provision of study information and a booklet about DS, they will consent to provide demographic information and fortnightly data about their seizures, and agree to see a psychiatrist three months later. We aim to recruit ~500 patients to this screening stage. After a review three months later by a psychiatrist, those patients who have continued to have DS in the previous eight weeks and who meet further eligibility criteria will be told about the trial comparing CBT + SMC vs SMC alone. If they are interested in participating, they will be given a further booklet on DS and study information. A research worker will see them to obtain their informed consent to take part in the RCT. We aim to randomise 298 people (149 to each arm). In addition to a baseline assessment, data will be collected at 6 and 12 months post randomisation. Our primary outcome is monthly seizure frequency in the preceding month. Secondary outcomes include seizure severity, measures of seizure freedom and reduction, psychological distress and psychosocial functioning, quality of life, health service use, cost effectiveness and adverse events. We will include a nested qualitative study to evaluate participants’ views of the intervention and factors that acted as facilitators and barriers to participation.
Discussion
This study will be the first adequately powered evaluation of CBT for this patient group and offers the potential to provide an evidence base for treating this patient group.
Trial registration
Current Controlled Trials
ISRCTN05681227
ClinicalTrials.gov
NCT02325544
Journal Article
Oscillating light engine realized by photothermal solvent evaporation
Continuous mechanical work output can be generated by using combustion engines and electric motors, as well as actuators, through on/off control via external stimuli. Solar energy has been used to generate electricity and heat in human daily life; however, the direct conversion of solar energy to continuous mechanical work has not been realized. In this work, a solar engine is developed using an oscillating actuator, which is realized through an alternating volume decrease of each side of a polypropylene/carbon black polymer film induced by photothermal-derived solvent evaporation. The anisotropic solvent evaporation and fast gradient diffusion in the polymer film sustains oscillating bending actuation under the illumination of divergent light. This light-driven oscillator shows excellent oscillation performance, excellent loading capability, and high energy conversion efficiency, and it can never stop with solvent supply. The oscillator can cyclically lift up a load and output work, exhibiting a maximum specific work of 30.9 × 10
−5
J g
−1
and a maximum specific power of 15.4 × 10
−5
W g
−1
under infrared light. This work can inspire the development of autonomous devices and provide a design strategy for solar engines.
Developing an oscillating actuator that can directly convert solar energy into mechanical energy is highly desirable. Here, authors report a solvent-assisted light-driven oscillator by porous film that achieves excellent oscillating actuation performance and can even oscillate by carrying a load under light irradiation.
Journal Article