The everyday use of assistive technology by people with dementia and their family carers: a qualitative study

Background: Assistive Technology (AT) has been suggested as a means by which people with dementia can be helped to live independently, while also leading to greater efficiencies in care. However little is known about how AT is being used by people with dementia and their carers in their daily routines. This paper reports on a qualitative study exploring the everyday use of AT by people with dementia and their families. Methods: The research employed a qualitative methodology. Semi structured interviews took place with 39 participants, 13 people with dementia and 26 carers. Key themes were identified using thematic analysis and the constant comparative method. Results: Three categories of AT use in everyday settings were identified; formal AT, accessed via social care services, ‘off the shelf AT' purchased privately, and ‘do it yourself' AT, everyday household products adapted by families to fulfil individual need in the absence of specific devices. Access to AT was driven by carers, with the majority of benefits being experienced by carers. Barriers to use included perceptions about AT cost; dilemmas about the best time to use AT; and a lack of information and support from formal health and social care services about how to access AT, where to source it and when and how it can be used. Conclusions: It has been argued that the ‘mixed economy' landscape, with private AT provision supplementing state provision of AT, is a key feature for the mainstreaming of AT services. Our data suggests that such a mixed economy is indeed taking place, with more participants using ‘off the shelf' and ‘DIY' AT purchased privately rather than via health and social care services. However this system has largely arisen due to an inability of formal care services to meet client needs. Such findings therefore raise questions about just who AT in its current provision is working for and whether a mixed market approach is the most appropriate provider model. Everyday technologies play an important role in supporting families with dementia to continue caring; further research is needed however to determine the most effective and person-centred models for future AT provision

Improving readiness for recruitment through simulated trial activation: the Adjuvant Steroids in Adults with Pandemic influenza (ASAP) trial

Background: Research in public health emergencies requires trials to be set up in readiness for activation at short notice and in anticipation of limited timelines for patient recruitment. We conducted a simulated activation of a hibernating pandemic influenza clinical trial in order to test trial processes and to determine the value of such simulation in maintaining trial readiness. Methods: The simulation involved the Nottingham Clinical Trials Unit, one participating hospital, one manufacturing unit and the Investigational Medicinal Product (IMP) supplier. During the exercise, from 15 September 2015 to 2 December 2015, clinical staff at the participating site completed the trial training package, a volunteer acting as a patient was recruited to the study, ‘dummy’ IMP was prescribed and follow-up completed. Results: Successful activation of the hibernating trial with patient recruitment within 4 weeks of ‘arousal’ as planned was demonstrated. A need for greater resilience in anticipation of staff absenteeism was identified, particularly in relation to key trial procedures where the potential for delay is high. A specific issue relating to the IMP Stock Control System was highlighted as a potential source of error that could compromise the randomisation sequence. The simulation exercise was well received by site investigators and increased their confidence in being able to meet the likely demands of the trial when activated. The estimated cost of the exercise was £1995; 90% of this being staff costs. Conclusions: Simulated activation is useful as a means to test, and prepare for, the rapid activation of ‘hibernating’ research studies. Whether simulation exercises can also help reduce waste in complex clinical trial research deserves further exploration

Personalisation, customisation and bricolage: how people with dementia and their families make assistive technology work for them

Assistive technologies (ATs) are being 'mainstreamed' within dementia care, where they are promoted as enabling people with dementia to age in place alongside delivering greater efficiencies in care. AT provision focuses upon standardised solutions, with little known about how ATs are used by people with dementia and their carers within everyday practice. This paper explores how people with dementia and carers use technologies in order to manage care. Findings are reported from qualitative semi-structured interviews with 13 people with dementia and 26 family carers. Readily available household technologies were used in conjunction with and instead of AT to address diverse needs, replicating AT functions when doing so. Successful technology use was characterised by ‘bricolage’ or the non-conventional use of tools or methods to address local needs. Carers drove AT use by engaging creatively with both assistive and everyday technologies, however, carers were not routinely supported in their creative engagements with technology by statutory health or social care services, making bricolage a potentially frustrating and wasteful process. Bricolage provides a useful framework to understand how technologies are used in the everyday practice of dementia care, and how technology use can be supported within care. Rather than implementing standardised AT solutions, AT services and AT design in future should focus on how technologies can support more personalised, adaptive forms of care

Plasma protein biomarkers for depression and schizophrenia by multi analyte profiling of case-control collections.

Despite significant research efforts aimed at understanding the neurobiological underpinnings of psychiatric disorders, the diagnosis and the evaluation of treatment of these disorders are still based solely on relatively subjective assessment of symptoms. Therefore, biological markers which could improve the current classification of psychiatry disorders, and in perspective stratify patients on a biological basis into more homogeneous clinically distinct subgroups, are highly needed. In order to identify novel candidate biological markers for major depression and schizophrenia, we have applied a focused proteomic approach using plasma samples from a large case-control collection. Patients were diagnosed according to DSM criteria using structured interviews and a number of additional clinical variables and demographic information were assessed. Plasma samples from 245 depressed patients, 229 schizophrenic patients and 254 controls were submitted to multi analyte profiling allowing the evaluation of up to 79 proteins, including a series of cytokines, chemokines and neurotrophins previously suggested to be involved in the pathophysiology of depression and schizophrenia. Univariate data analysis showed more significant p-values than would be expected by chance and highlighted several proteins belonging to pathways or mechanisms previously suspected to be involved in the pathophysiology of major depression or schizophrenia, such as insulin and MMP-9 for depression, and BDNF, EGF and a number of chemokines for schizophrenia. Multivariate analysis was carried out to improve the differentiation of cases from controls and identify the most informative panel of markers. The results illustrate the potential of plasma biomarker profiling for psychiatric disorders, when conducted in large collections. The study highlighted a set of analytes as candidate biomarker signatures for depression and schizophrenia, warranting further investigation in independent collections

Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory

Background Case management has been suggested as a way of improving the quality and cost-effectiveness of support for people with dementia. In this study we adapted and implemented a successful United States’ model of case management in primary care in England. The results are reported elsewhere, but a key finding was that little case management took place. This paper reports the findings of the process evaluation which used Normalization Process Theory to understand the barriers to implementation. Methods Ethnographic methods were used to explore the views and experiences of case management. Interviews with 49 stakeholders (patients, carers, case managers, health and social care professionals) were supplemented with observation of case managers during meetings and initial assessments with patients. Transcripts and field notes were analysed initially using the constant comparative approach and emerging themes were then mapped onto the framework of Normalization Process Theory. Results The primary focus during implementation was on the case managers as isolated individuals, with little attention being paid to the social or organizational context within which they worked. Barriers relating to each of the four main constructs of Normalization Process Theory were identified, with a lack of clarity over the scope and boundaries of the intervention (coherence); variable investment in the intervention (cognitive participation); a lack of resources, skills and training to deliver case management (collective action); and limited reflection and feedback on the case manager role (reflexive monitoring). Conclusions Despite the intuitive appeal of case management to all stakeholders, there were multiple barriers to implementation in primary care in England including: difficulties in embedding case managers within existing well-established community networks; the challenges of protecting time for case management; and case managers’ inability to identify, and act on, emerging patient and carer needs (an essential, but previously unrecognised, training need). In the light of these barriers it is unclear whether primary care is the most appropriate setting for case management in England. The process evaluation highlights key aspects of implementation and training to be addressed in future studies of case management for dementia

Perennial flower margins reduce orchard fruit damage by rosy apple aphid, Dysaphis plantaginea (Homoptera: Aphididae)

Sown or natural flower strips are a commonly used management practice in agroecosystems and have been demonstrated to increase the abundance of predators of orchard pests. There is less evidence of the extent to which such strips can reduce pest damage in orchards. Here we examined the effect of managed, perennial flower margins on fruit damage by an economically significant crop pest, Dysaphis plantaginea, rosy apple aphid, in conventional apple orchards over 2 years, compared to orchards without flower margins. We found orchard flower margins reduced the percentage of apple trees with fruit damage by D. plantaginea, from 80% to 48%. In 2021, a period of severe infestation (65% of trees had fruit damage), there was reduced spread of D. plantaginea on infested apple trees and the number of trees with fruit damage was significantly reduced up to 50 m into orchards. During 2022, a period of lower infestation (25% of trees damaged), fruit damage was significantly reduced up to 10 m from the flower margin. A significant reduction in predation of aphids from bait cards in flower margin compared with control orchards suggests specialists, rather than generalist predators, may be driving the positive effects of the margin on pest pressure. There was no significant effect of flower margins on abundance of important aphid predators, including Syrphidae (hoverflies) and Coccinellidae (ladybirds). Synthesis and applications: To our knowledge, this study is the first to detect a reduction in fruit damage by pests at harvest in orchards with a flower margin. We highlight the potential for established perennial flower margins to deliver measurable, sustainable, D. plantaginea control benefits and provide insights into the optimal spatial arrangement of flower strips in orchards

Flower margins: attractiveness over time for different pollinator groups

Supporting biodiversity in agricultural landscapes is key from both a conservation and ecosystem services perspective. Planting flower margins along crop field edges is one of the most established approaches to try and improve habitat and resources for insect pollinators on farms. Whilst there is growing evidence that these margins can result in increased pollinator abundance and diversity on farms in the short-term, there is little data looking at how these margins perform over longer periods. This study looked at the utilization of pollinator-friendly margins over time in an agricultural landscape in Hungary. ‘Operation Pollinator’ seed mixes with 12 species, were used at 96 farms in Hungary from 2010 to 2018. Insect pollinators were recorded on the sown flower margins and control margins (with naturally occurring vegetation) using walked transects. Repeated sampling of the margins was done over several years so that data was collected on margins from 0 (planted that season) to 7 years old. The abundance of pollinators in the Operation Pollinator flower margins was greater than in control margins for all groups recorded (honey bees, bumble bees, mining bees, trap-nesting bees, hoverflies and Lepidoptera). The biggest relative increase in abundance was in honey bees (768% increase in average abundance in the flower margin compared to the control across all observations), with mining (566%) and bumble bees (414%) showing the next largest increases. The abundance of bumble bees, trap-nesting bees and Lepidoptera in the margins did not vary with the age of the margin. Honey bees, mining bees and hoverflies all decreased in abundance with increasing margin age, as did flower abundance. The results suggest that for some pollinator groups, regardless of age, flower margins provide important resources in the agricultural landscape. However, this is not universally true and for certain pollinator groups, some re-sowing of the margins may be needed to sustain longer-term benefits

Using unoccupied aerial vehicles (UAVs) to map seagrass cover from Sentinel-2 imagery

Seagrass habitats are ecologically valuable and play an important role in sequestering and storing carbon. There is, thus, a need to estimate seagrass percentage cover in diverse environments in support of climate change mitigation, marine spatial planning and coastal zone management. In situ approaches are accurate but time-consuming, expensive and may not represent the larger spatial units collected by satellite imaging. Hence, there is a need for a consistent methodology that uses accurate point-based field surveys to deliver high-quality mapping of percentage seagrass cover at large spatial scales. Here, we develop a three-step approach that combines in situ (quadrats), aerial (unoccupied aerial vehicle—UAV) and satellite data to map percentage seagrass cover at Turneffe Atoll, Belize, the largest atoll in the northern hemisphere. First, the optical bands of four UAV images were used to calculate seagrass cover, in combination with in situ data. The seagrass cover calculated from the UAV was then used to develop training and validation datasets to estimate seagrass cover in Sentinel-2 pixels. Next, non-seagrass areas were identified in the Sentinel-2 data and removed by object-based classification, followed by a pixel-based regression to calculate seagrass percentage cover. Using this approach, percentage seagrass cover was mapped using UAVs (R2 = 0.91 between observed and mapped distributions) and using Sentinel-2 data (R2 = 0.73). This work provides the first openly available and explorable map of seagrass percentage cover across Turneffe Atoll, where we estimate approximately 242 km2 of seagrass above 10% cover is located. We estimate that this approach offers 30 times more data for training satellite data than traditional methods, therefore presenting a substantial reduction in cost-per-point for data. Furthermore, the increase in data helps deliver a high-quality seagrass cover map, suitable for resolving trends of deteriorating, stable or recovering seagrass environments at 10 m2 resolution to underpin evidence-based management and conservation of seagrass.publishedVersio

Gentamicin compared with ceftriaxone for the treatment of gonorrhoea (G-ToG): a randomised non-inferiority trial

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Background: Gonorrhoea is a common sexually transmitted infection for which ceftriaxone is the current first-line treatment, but antimicrobial resistance is emerging. The objective of this study was to assess the effectiveness of gentamicin as an alternative to ceftriaxone (both combined with azithromycin) for treatment of gonorrhoea. Methods: G-ToG was a multicentre, parallel-group, pragmatic, randomised, non-inferiority trial comparing treatment with gentamicin to treatment with ceftriaxone for patients with gonorrhoea. The patients, treating physician, and assessing physician were masked to treatment but the treating nurse was not. The trial took place at 14 sexual health clinics in England. Adults aged 16–70 years were eligible for participation if they had a diagnosis of uncomplicated genital, pharyngeal, or rectal gonorrhoea. Participants were randomly assigned to receive a single intramuscular dose of either gentamicin 240 mg (gentamicin group) or ceftriaxone 500 mg (ceftriaxone group). All participants also received a single 1 g dose of oral azithromycin. Randomisation (1:1) was stratified by clinic and performed using a secure web-based system. The primary outcome was clearance of Neisseria gonorrhoeae at all initially infected sites, defined as a negative nucleic acid amplification test 2 weeks post treatment. Primary outcome analyses included only participants who had follow-up data, irrespective of the baseline visit N gonorrhoeae test result. The margin used to establish non-inferiority was a lower confidence limit of 5% for the risk difference. This trial is registered with ISRCTN, number ISRCTN51783227. Findings: Of 1762 patients assessed, we enrolled 720 participants between Oct 7, 2014, and Nov 14, 2016, and randomly assigned 358 to gentamicin and 362 to ceftriaxone. Primary outcome data were available for 306 (85%) of 362 participants allocated to ceftriaxone and 292 (82%) of 358 participants allocated to gentamicin. At 2 weeks after treatment, infection had cleared for 299 (98%) of 306 participants in the ceftriaxone group compared with 267 (91%) of 292 participants in the gentamicin group (adjusted risk difference −6·4%, 95% CI −10·4% to −2·4%). Of the 328 participants who had a genital infection, 151 (98%) of 154 in the ceftriaxone group and 163 (94%) of 174 in the gentamicin group had clearance at follow-up (adjusted risk difference −4·4%, −8·7 to 0). For participants with a pharyngeal infection, a greater proportion receiving ceftriaxone had clearance at follow-up (108 [96%] in the ceftriaxone group compared with 82 [80%] in the gentamicin group; adjusted risk difference −15·3%, −24·0 to −6·5). Similarly, a greater proportion of participants with rectal infection in the ceftriaxone group had clearance (134 [98%] in the ceftriaxone group compared with 107 [90%] in the gentamicin group; adjusted risk difference −7·8%, −13·6 to −2·0). Thus, we did not find that a single dose of gentamicin 240 mg was non-inferior to a single dose of ceftriaxone 500 mg for the treatment of gonorrhoea, when both drugs were combined with a 1 g dose of oral azithromycin. The side-effect profiles were similar between groups, although severity of pain at the injection site was higher for gentamicin (mean visual analogue pain score 36 of 100 in the gentamicin group vs 21 of 100 in the ceftriaxone group). Interpretation: Gentamicin is not appropriate as first-line treatment for gonorrhoea but remains potentially useful for patients with isolated genital infection, or for patients who are allergic or intolerant to ceftriaxone, or harbour a ceftriaxone-resistant isolate. Further research is required to identify and test new alternatives to ceftriaxone for the treatment of gonorrhoea. Funding: UK National Institute for Health Research

Using unoccupied aerial vehicles (UAVs) to map seagrass cover from Sentinel-2 imagery

Seagrass habitats are ecologically valuable and play an important role in sequestering and storing carbon. There is, thus, a need to estimate seagrass percentage cover in diverse environments in support of climate change mitigation, marine spatial planning and coastal zone management. In situ approaches are accurate but time-consuming, expensive and may not represent the larger spatial units collected by satellite imaging. Hence, there is a need for a consistent methodology that uses accurate point-based field surveys to deliver high-quality mapping of percentage seagrass cover at large spatial scales. Here, we develop a three-step approach that combines in situ (quadrats), aerial (unoccupied aerial vehicle—UAV) and satellite data to map percentage seagrass cover at Turneffe Atoll, Belize, the largest atoll in the northern hemisphere. First, the optical bands of four UAV images were used to calculate seagrass cover, in combination with in situ data. The seagrass cover calculated from the UAV was then used to develop training and validation datasets to estimate seagrass cover in Sentinel-2 pixels. Next, non-seagrass areas were identified in the Sentinel-2 data and removed by object-based classification, followed by a pixel-based regression to calculate seagrass percentage cover. Using this approach, percentage seagrass cover was mapped using UAVs (R2 = 0.91 between observed and mapped distributions) and using Sentinel-2 data (R2 = 0.73). This work provides the first openly available and explorable map of seagrass percentage cover across Turneffe Atoll, where we estimate approximately 242 km2 of seagrass above 10% cover is located. We estimate that this approach offers 30 times more data for training satellite data than traditional methods, therefore presenting a substantial reduction in cost-per-point for data. Furthermore, the increase in data helps deliver a high-quality seagrass cover map, suitable for resolving trends of deteriorating, stable or recovering seagrass environments at 10 m2 resolution to underpin evidence-based management and conservation of seagrass