Addressing design and suitability barriers to Telecare use: Has anything changed?

BACKGROUND: Issues relating to design and suitability of Telecare were raised twenty years ago. We explored the views of non-users of Telecare and examined whether design-related barriers exist today despite significant technological advances. OBJECTIVE: To examine the reasons why people choose not to adopt Telecare, with specific focus on reasons relating to design and suitability of the intervention. METHODS: Individual qualitative semi-structured interviews were conducted with people who were not using or had actively declined Telecare, a voice which is rarely heard in Telecare-barrier research. Framework analysis was used to identify existing and emergent themes for n=22 participants. RESULTS: Sub-themes relating to design and suitability of Telecare were explored: Stigma, i.e. Telecare as symbolising old age and lost independence; Design, including stigmatising aesthetics and inappropriate use; Alternative options, i.e. propensity to seek non-Telecare solutions; Awareness of the devices and service; and Cost. CONCLUSIONS: Barriers to Telecare use are similar for both users and non-users. Our results indicate that design-related barriers have yet to be addressed despite the technological revolution. The cost model of Telecare services is becoming more consumer-driven. Thus Telecare design needs to exploit technological advances in order to improve wellbeing and allow individuals their choice and independence

Making Telecare desirable rather than a last resort

Despite reported benefits of Telecare use for older adults, uptake of Telecare in the United Kingdom remains relatively low. Non-users of Telecare are an under-researched group in the Telecare field. We conducted 22 qualitative individual semi-structured interviews to explore the views and opinions of current non-users of Telecare regarding barriers and facilitators to its use, and explored considerations which may precede their decision to accept, or reject, Telecare. Framework analysis identified a number of themes which influence the outcome and timing of this decision, including peace of mind (for the individual and their family), the strength and composition of an individual's support network, the impact of changing personal and health circumstances, and lack of communication about Telecare (e.g. advertising). A cost–benefit decision process appears to take place for the potential user, whereby the benefit of peace of mind is weighed against perceived ‘costs’ of using Telecare. Telecare is often perceived as a last resort rather than a preventative measure. A number of barriers to Telecare use need to be addressed if individuals are to make fully informed decisions regarding their Telecare use, and to begin using Telecare at a time when it could provide them with optimal benefit. Although the study was set in England, the findings may be relevant for other countries where Telecare is used

Probing the primordial power spectra with inflationary priors

We investigate constraints on power spectra of the primordial curvature and tensor perturbations with priors based on single-field slow-roll inflation models. We stochastically draw the Hubble slow-roll parameters and generate the primordial power spectra using the inflationary flow equations. Using data from recent observations of CMB and several measurements of geometrical distances in the late Universe, Bayesian parameter estimation and model selection are performed for models that have separate priors on the slow-roll parameters. The same analysis is also performed adopting the standard parameterization of the primordial power spectra. We confirmed that the scale-invariant Harrison-Zel'dovich spectrum is disfavored with increased significance from previous studies. While current observations appear to be optimally modeled with some simple models of single-field slow-roll inflation, data is not enough constraining to distinguish these models.Comment: 23 pages, 3 figures, 7 tables, accepted for publication in JCA

The use of a smartphone app and an activity tracker to promote physical activity in the management of chronic obstructive pulmonary disease : randomized controlled feasibility study

Background: Chronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR). Objective: This study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness. Methods: We conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity–based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology. Results: Overall, 47% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation. Conclusions: mHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates

Mineral analysis reveals extreme manganese concentrations in wild harvested and commercially available edible termites

Open Access Journal; Published online: 09 April 2020Termites are widely used as a food resource, particularly in Africa and Asia. Markets for insects as food are also expanding worldwide. To inform the development of insect-based foods, we analysed selected minerals (Fe-Mn-Zn-Cu-Mg) in wild-harvested and commercially available termites. Mineral values were compared to selected commercially available insects. Alate termites, of the genera Macrotermes and Odontotermes, showed remarkably high manganese (Mn) content (292–515 mg/100 gdw), roughly 50–100 times the concentrations detected in other insects. Other mineral elements occur at moderate concentrations in all insects examined. On further examination, the Mn is located primarily in the abdomens of the Macrotermes subhyalinus; with scanning electron microscopy revealing small spherical structures highly enriched for Mn. We identify the fungus comb, of Macrotermes subhyanus, as a potential biological source of the high Mn concentrations. Consuming even small quantities of termite alates could exceed current upper recommended intakes for Mn in both adults and children. Given the widespread use of termites as food, a better understanding the sources, distribution and bio-availability of these high Mn concentrations in termite alates is needed

Inhibition of glutamine metabolism accelerates resolution of acute lung injury

Despite recent advances, acute respiratory distress syndrome (ARDS) remains a severe and often fatal disease for which there is no therapy able to reduce the underlying excessive lung inflammation or enhance resolution of injury. Metabolic programming plays a critical role in regulating inflammatory responses. Due to their high metabolic needs, neutrophils, macrophages, and lymphocytes rely upon glutamine metabolism to support activation and function. Additionally, during times of physiologic stress, nearly all cells, including fibroblasts and epithelial cells, require glutamine metabolism. We hypothesized that inhibiting glutamine metabolism reduces lung inflammation and promotes resolution of acute lung injury. Lung injury was induced by instilling lipopolysaccharide (LPS) intratracheally. To inhibit glutamine metabolism, we administered a glutamine analogue, 6-diazo-5-oxo-L-norleucine (DON) that binds to glutamine-utilizing enzymes and transporters, after injury was well established. Treatment with DON led to less lung injury, fewer lung neutrophils, lung inflammatory and interstitial macrophages, and lower levels of proinflammatory cytokines and chemokines at 5 and/or 7 days after injury. Additionally, DON led to earlier expression of the growth factor amphiregulin and more rapid recovery of LPS-induced weight loss. Thus, DON reduced lung inflammation and promoted resolution of injury. These data contribute to our understanding of how glutamine metabolism regulates lung inflammation and repair, and identifies a novel target for future therapies for ARDS and other inflammatory lung diseases

Deletion of mtorc1 activity in CD4+ T cells is associated with lung fibrosis and increased γδ T cells

Pulmonary fibrosis is a devastating, incurable disease in which chronic inflammation and dysregulated, excessive wound healing lead to progressive fibrosis, lung dysfunction, and ultimately death. Prior studies have implicated the cytokine IL-17A and Th17 cells in promoting the development of fibrosis. We hypothesized that loss of Th17 cells via CD4-specific deletion of mTORC1 activity would abrogate the development of bleomycin-induced pulmonary fibrosis. However, in actuality loss of Th17 cells led to increased mortality and fibrosis in response to bleomycin. We found that in the absence of Th17 cells, there was continued production of IL-17A by γδT cells. These IL-17A+γδT cells were associated with increased lung neutrophils and M2 macrophages, accelerated development of fibrosis, and increased mortality. These data elucidate the critical role of IL-17A+ γδT cells in promoting chronic inflammation and fibrosis, and reveal a novel therapeutic target for treatment of pulmonary fibrosis

Single-field inflation constraints from CMB and SDSS data

We present constraints on canonical single-field inflation derived from WMAP five year, ACBAR, QUAD, BICEP data combined with the halo power spectrum from SDSS LRG7. Models with a non-scale-invariant spectrum and a red tilt n_s < 1 are now preferred over the Harrison-Zel'dovich model (n_s = 1, tensor-to-scalar ratio r = 0) at high significance. Assuming no running of the spectral indices, we derive constraints on the parameters (n_s, r) and compare our results with the predictions of simple inflationary models. The marginalised credible intervals read n_s = 0.962^{+0.028}_{-0.026} and r < 0.17 (at 95% confidence level). Interestingly, the 68% c.l. contours favour mainly models with a convex potential in the observable region, but the quadratic potential model remains inside the 95% c.l. contours. We demonstrate that these results are robust to changes in the datasets considered and in the theoretical assumptions made. We then consider a non-vanishing running of the spectral indices by employing different methods, non-parametric but approximate, or parametric but exact. With our combination of CMB and LSS data, running models are preferred over power-law models only by a Delta chi^2 ~ 5.8, allowing inflationary stages producing a sizable negative running -0.063^{+0.061}_{-0.049} and larger tensor-scalar ratio r < 0.33 at the 95% c.l. This requires large values of the third derivative of the inflaton potential within the observable range. We derive bounds on this derivative under the assumption that the inflaton potential can be approximated as a third order polynomial within the observable range.Comment: 32 pages, 7 figures. v2: additional references, some typos corrected, passed to JCAP style. v3: minor changes, matches published versio

SETD2 haploinsufficiency for microtubule methylation is an early driver of genomic instability in renal cell carcinoma

Loss of the short arm of chromosome 3 (3p) occurs early in >95% of clear cell renal cell carcinoma (ccRCC). Nearly ubiquitous 3p loss in ccRCC suggests haploinsufficiency for 3p tumor suppressors as early drivers of tumorigenesis. We previously reported methyltransferase SETD2, which trimethylates H3 histones on lysine 36 (H3K36me3) and is located in the 3p deletion, to also trimethylate microtubules on lysine 40 (aTubK40me3) during mitosis, with aTubK40me3 required for genomic stability. We now show that monoallelic, Setd2-deficient cells retaining H3K36me3, but not aTubK40me3, exhibit a dramatic increase in mitotic defects and micronuclei count, with increased viability compared with biallelic loss. In SETD2-inactivated human kidney cells, rescue with a pathogenic SETD2 mutant deficient for microtubule (aTubK40me3), but not histone (H3K36me3) methylation, replicated this phenotype. Genomic instability (micronuclei) was also a hallmark of patient-derived cells from ccRCC. These data show that the SETD2 tumor suppressor displays a haploinsufficiency phenotype disproportionately impacting microtubule methylation and serves as an early driver of genomic instability. Significance: Loss of a single allele of a chromatin modifier plays a role in promoting oncogenesis, underscoring the growing relevance of tumor suppressor haploinsufficiency in tumorigenesis