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The quality, skills and attitudes of staff working in the healthcare system are central to multidisciplinary learning and working, and to the delivery of the quality of care patients expect. Patients want to know that the staff supporting them have the right knowledge and attitudes to work in partnership, particularly for conditions such as diabetes where 95% of all care is delivered by the person with diabetes themselves. With the current changes in the NHS structures in England, and the potential for greater variation in the types of 'qualified provider', along with the recent scandal at Mid-Staffordshire Hospital, staff need to be shown to be competent and named/accredited or recognized as such. This will help to restore faith in an increasingly devolved delivery structure. The education and validation of competency needs to be consistently delivered and assured to ensure standards are maintained for different roles and disciplines across each UK nation. Diabetes UK recommends that all NHS organizations prioritize healthcare professional education, training and competency through the implementation of a National Diabetes Competency Framework and the phased approach to delivery to address this need. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

We describe new manufacturing techniques and physical properties of an improved polymer-based longitudinal intrafascicular electrode (polyLIFE). Modifications were made to correct: (1) poor metal film adhesion and fatigue resistance, (2) inconsistent insulation adhesion and control over recording/stimulation zone length, and (3) insufficient tensile strength for clinical use. Metal adhesion was significantly improved by both plasma treatment and fiber rotation (about the long axis) during metal deposition. Fatigue resistance was improved by reduction in sputtering energy (time x power) combined with long axis rotation, resulting in thin metal films that were 250 times more resistant to cyclic bending fatigue. Insulation adhesion was enhanced with the application of an adhesion-promoting silicone (MED2-4013, Nusil), while the recording/stimulation zone length was controlled to 1 +/- 0.2mm (mean +/- S.D.). The polyLIFE was made more robust by the inclusion of three individually metallized fibers, improving its tensile strength by a factor of 4 while producing minimal changes to its overall stiffness. However, the metallized fiber redundancy did not significantly affect fatigue resistance. The manufacturing changes described in this study enable the construction of more mechanically robust polyLIFEs, which should provide greater success when chronically implanted in peripheral nerves.

Polymer-based longitudinal intrafascicular electrodes (polyLIFEs) were chronically implanted into the sciatic nerve of white New Zealand rabbits (n=8) for a period of 6 months (hereafter referred to as the long-term group). The impact of the implantation procedure, as observed 6 months post surgery, was evaluated in a sham-treated control group (n=9). The contralateral sciatic nerve served as the control for each animal. Nerve-fiber counts, fiber diameters, and myelin thickness were estimated at the level of the implant site, 1.5 cm proximally, and 1.5 cm distally for both nerves in sham-treated and long-term groups. Implantation of polyLIFEs had no significant effect on fiber counts, nerve-fiber diameter, or myelin thickness. A slight increase in connective tissue in the vicinity of the implant site was evident in the long-term group, including a thin but dense capsule immediately surrounding the implanted electrode.

The objective was to characterize nerve-cuff recordings of muscle afferents to joint rotation over a large part of the physiological joint range. This information is needed to develop control strategies for functional electrical stimulation (FES) systems using muscle afferent signals for sensory feedback. Five acute rabbit experiments were performed. Tripolar cuff electrodes were implanted around the tibial and peroneal divisions of the sciatic nerve in the rabbit's left leg. The electroneurograms (ENG) were recorded during passive ankle rotation, using a ramp-and-hold profile starting at seven different joint positions (excursion=5/spl deg/, velocity=10/spl deg//s, initial positions 60/spl deg/, 70/spl deg/, 80/spl deg/, 90/spl deg/, 100/spl deg/, 110/spl deg/, and 120/spl deg/). The amplitude of the afferent activity was dependent on the initial joint position. The steady-state sensitivity of both nerve responses increased with increasing joint flexion, whereas the dynamic sensitivity increased initially but then decreased. The results indicate that recordings of the muscle afferents may provide reliable information over only a part of the physiological joint range, Despite this limitation, muscle afferent activity may be useful for motion feedback if the movement to be controlled is within a narrow joint range such as postural sway.

Flash photolysis has been used to initiate electron transfer from excited tris(2,2′-bipyridyl)ruthenium(II) to the Cu_A site of a soluble domain from subunit II of Thermus thermophilus cytochrome ba_3. Luminescence quenching of the excited state of the ruthenium(II) complex was observed at low protein concentrations (20–200 μM Cu_A domain), with second-order rate constants of 2.9 × 10^9 and 1.3 × 10^9 M^(−1) s^(−1) at low and high ionic strength, respectively. Transient absorption measurements demonstrate that 10–20% of the quenching arises from electron transfer (ET). At high protein concentrations (>250 μM Cu_A) and low ionic strength (5 mM Tris, pH 8.1), the quenching rate saturates due to ground-state complex formation; a first-order rate constant of 1.5 × 10^5 s^(−1) was estimated for ET in the complex. Given the high driving forces involved (ΔG° = 1.1 eV), it is possible that these ET reactions occur in the inverted driving-force regime. Spectroscopic measurements indicate that the T. thermophilus Cu_A domain and horse heart cytochrome c form a complex at low ionic strength, with an apparent dissociation constant K_d ∼ 5 μM.

Purpose It is not known whether motor and sensory pathways associated with a missing or denervated limb remain functionally intact over periods of many months or years after amputation or chronic peripheral nerve transection injury. We examined the extent to which activity on chronically severed motor nerve fibers could be controlled by human amputees and whether distally referred tactile and proprioceptive sensations could be induced by stimulation of sensory axons in the nerve stumps. Methods Amputees undergoing elective stump procedures were invited to participate in this study. Longitudinal intrafascicular electrodes were threaded percutaneously and implanted in severed nerves of human amputees. The electrodes were interfaced to an amplifier and stimulator system controlled by a laptop computer. Electrophysiologic tests were conducted for 2 consecutive days after recovery from the surgery. Results It was possible to record volitional motor nerve activity uniquely associated with missing limb movements. Electrical stimulation through the implanted electrodes elicited discrete, unitary, graded sensations of touch, joint movement, and position, referring to the missing limb. Conclusions These findings indicate that both central and peripheral motor and somatosensory pathways retain significant residual connectivity and function for many years after limb amputation. This implies that peripheral nerve interfaces could be used to provide amputees with prosthetic limbs that have more natural feel and control than is possible with current myoelectric and body-powered control systems.

The authors implanted 11 polymer-based intrafascicular electrodes into the peroneal and/or tibial branches of the right sciatic nerve in 8 New Zealand white rabbits for a period of 6 months where the contralateral limb served as the control. The fiber diameter distributions, myelin thickness, and axon counts were measured at the level of the implant, 1.5 cm proximally, and 1.5 cm distally. PolyLIFEs caused no significant effect on axon counts or diameter, but induced slight demyelination distal to the implant. Encapsulation of the implants was also minimal.

Polymer-based longitudinal intrafascicular electrodes (polyLIFEs) were chronically implanted into the sciatic nerve of white New Zealand rabbits (n=8) for a period of 6 months (hereafter referred to as the long-term group). The impact of the implantation procedure, as observed 6 months post surgery, was evaluated in a sham-treated control group (n=9). The contralateral sciatic nerve served as the control for each animal. Nerve-fiber counts, fiber diameters, and myelin thickness were estimated at the level of the implant site, 1.5 cm proximally, and 1.5 cm distally for both nerves in sham-treated and long-term groups. Implantation of polyLIFEs had no significant effect on fiber counts, nerve-fiber diameter, or myelin thickness. A slight increase in connective tissue in the vicinity of the implant site was evident in the long-term group, including a thin but dense capsule immediately surrounding the implanted electrode.

New designs of cuff electrodes for the recording of signals from peripheral nerves are typically tested in acute animal experiments before long-term evaluation takes place. A reproducible, cost-effective and fast method is presented for evaluating cuff electrodes with respect to signal amplitude, noise rejection, and, in some cases, selectivity, as an alternative to acute in vivo experiments. Comparisons with a computer model and with signals obtained from rabbit tibial nerve give good agreement with the new method. It is shown that an imperfect closure of the cuff around the nerve can easily lead to more than 50% loss of the signal amplitude. Noise from sources external to the cuff is not significantly affected by the closing mechanism, but is strongly reduced by a tripolar cuff configuration as compared with a monopolar one (reduction factor 2.8 to 58, mean = 6.5, n = 6). In dual-channel cuffs, cross-talk is below 1.2% indicating a very high selectivity.

We examined the recording characteristics of two different types of polymer-based longitudinal intrafascicular electrodes (LIFEs) in peripheral nerve: single-stranded (s-polyLIFEs) and multistranded (m-polyLIFEs). Recordings were also made from Pt-Ir wire-based electrodes (PtIrLIFEs) as a control. The electrodes were implanted in either tibial or medial gastrocnemius branches of the rabbit sciatic nerve, and in the sciatic nerve of rats. Recorded neural activity induced by manually elicited afferent neural activity showed that both polyLIFE versions performed comparably to PtIrLIFEs.