Informing evaluation of a smartphone application for people with acquired brain injury: a stakeholder engagement study

Background Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement. Methods We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire responses. Results We engaged with 20 ABI survivors, 5 carers, 25 professionals, 41 questionnaires were completed by stakeholders. Comments made during group discussions were supported by questionnaire results. Enablers included smartphone competency (capability), personalisation of app (opportunity), and identifying perceived need (motivation). Barriers included a physical and cognitive inability to use smartphone (capability), potential cost and reliability of technology (opportunity), and no desire to use technology or change from existing strategies (motivation). The stakeholders identified potential uses and changes to the app, which were not easily mapped onto the behaviour change wheel, e.g. monitoring fatigue levels, method of logging task completion, and editing the diary on their smartphone. Conclusions The study identified that both ABI survivors and therapists could see a use for Brain in Hand, but wanted users to be able to personalise it themselves to address individual user needs, e.g. monitoring activity levels. The behaviour change wheel is a useful tool when designing and evaluating engagement activities as it addresses most aspects of implementation, however additional categories may be needed to explore the specific features of assistive technology interventions, e.g. technical functions

Perceived skill challenges and possible solutions for ACCP EDTR PRN members accomplishing scholarly activity.

Published abstract in: Pharmacotherapy

Alternating Wenckebach Periods and Allied Arrhythmias

Alternating Wenckebach periods (AWPs)are episodes of 2:1 block during which Ihe PR, AH, or AV intervals of the conducted beats gradually increase until a greater degree of block ensues. Most episodes occur at the AVnode, but some have aiso been reported in other structures. AWPs are usually attributed to multilevel block due to transverse (horizontal)dissociation. This assumption was initially based on a method in which the solutions to difficult electrocardiographic rhythms were arrived at by analysis and deduction based on the knowledge existing at that particular time. Subsequently, it was reinforced by information extrapolated from intracardiac recordings performed in patients with documented multilevel block in separate anatomical structures (atria, AV node, and His bundle), as well as from microelectrode studies and computer simulations. Although AWPs are frequently observed in clinical tracings, those occurring at the AV node are best categorized during incremental atrial stimulation because then they occupy a specific point in the wide spectrum of tachycardia dependent AV nodal conduction disturbances. In fact, the A:H ratios occurring in the episodes where the degree of block increases can be represented by “universal” mathematical formulas. However, in the clinical setting, drugs affecting the electrophysiology of the node can alter the pacing induced symmetry by producing additional differential effects on the various levels. The latter still requires further elucidation

Understanding a migratory species in a changing world: climatic effects and demographic declines in the western monarch revealed by four decades of intensive monitoring

Migratory animals pose unique challenges for conservation biologists, and we have much to learn about how migratory species respond to drivers of global change. Research has cast doubt on the stability of the eastern monarch butterfly (Danaus plexippus) population in North America, but the western monarchs have not been as intensively examined. Using a Bayesian hierarchical model, sightings of western monarchs over approximately 40 years were investigated using summer flight records from ten sites along an elevational transect in Northern California. Multiple weather variables were examined, including local and regional temperature and precipitation. Population trends from the ten focal sites and a subset of western overwintering sites were compared to summer and overwintering data from the eastern migration. Records showed western overwintering grounds and western breeding grounds had negative trends over time, with declines concentrated early in the breeding season, which were potentially more severe than in the eastern population. Temporal variation in the western monarch also appears to be largely independent of (uncorrelated with) the dynamics in the east. For our focal sites, warmer temperatures had positive effects during winter and spring, and precipitation had a positive effect during spring. These climatic associations add to our understanding of biotic-abiotic interactions in a migratory butterfly, but shifting climatic conditions do not explain the overall, long-term, negative population trajectory observed in our data