Investigating the use of mobile technology to promote active lifestyles and improved glycaemic control in individuals with type 2 diabetes

The purpose of this thesis was to examine the potential of using mobile technology to promote active lifestyles and improved glycaemic control in individuals with Type 2 diabetes. Chapter 1 introduced the research area, thesis rationale, and the design and structure of the thesis. Five studies were undertaken as part of this thesis. This first (Chapter 2) was a systematic and integrated literature review examining the effectiveness, acceptability and feasibility of using mobile technology to promote active living in adults with Type 2 Diabetes. The second (Chapter 3) presented the challenges and solutions of combining glucose and activity data sets measured continuously using mobile technology. The third (Chapter 4) examined the physical activity, sedentary behaviour and glucose patterns of adults with Type 2 diabetes in a free-living setting using mobile technology. The fourth (Chapter 5) examined the individual glycaemic response in adults with Type 2 Diabetes to interrupting prolonged sedentary behaviour in a controlled setting. Study five (Chapter 6) explored the experiences of, and attitudes towards, using mobile technologies to promote active living in adults with Type 2 diabetes. The final chapter (Chapter 7) discussed the findings of these studies in the wider context of the thesis and how the findings can be used to positively impact diabetes care and future research.The purpose of this thesis was to examine the potential of using mobile technology to promote active lifestyles and improved glycaemic control in individuals with Type 2 diabetes. Chapter 1 introduced the research area, thesis rationale, and the design and structure of the thesis. Five studies were undertaken as part of this thesis. This first (Chapter 2) was a systematic and integrated literature review examining the effectiveness, acceptability and feasibility of using mobile technology to promote active living in adults with Type 2 Diabetes. The second (Chapter 3) presented the challenges and solutions of combining glucose and activity data sets measured continuously using mobile technology. The third (Chapter 4) examined the physical activity, sedentary behaviour and glucose patterns of adults with Type 2 diabetes in a free-living setting using mobile technology. The fourth (Chapter 5) examined the individual glycaemic response in adults with Type 2 Diabetes to interrupting prolonged sedentary behaviour in a controlled setting. Study five (Chapter 6) explored the experiences of, and attitudes towards, using mobile technologies to promote active living in adults with Type 2 diabetes. The final chapter (Chapter 7) discussed the findings of these studies in the wider context of the thesis and how the findings can be used to positively impact diabetes care and future research

Dose-response between frequency of breaks in sedentary time and glucose control in type 2 diabetes: a proof of concept study

Objectives This study aimed to investigate dose-response between frequency of breaks in sedentary time and glucose control.DesignRandomised three-treatment, two-period balanced incomplete block trial.MethodsTwelve adults with type 2 diabetes (age, 60 ± 11 years; body mass index, 30.2 ± 4.7 kg/m2) participated in two of the following treatment conditions: sitting for 7 h interrupted by 3 min light-intensity walking breaks every (1) 60 min (Condition 1), (2) 30 min (Condition 2), and (3) 15 min (Condition 3). Postprandial glucose incremental area under the curves (iAUCs) and 21-h glucose total area under the curve (AUC) were measured using continuous glucose monitoring. Standardised meals were provided. Results Compared with Condition 1 (6.7 ± 0.8 mmol L−1 × 3.5 h−1), post-breakfast glucose iAUC was reduced for Condition 3 (3.5 ± 0.9 mmol L−1 × 3.5 h−1, p ˂ 0.04). Post-lunch glucose iAUC was lower in Condition 3 (1.3 ± 0.9 mmol L−1 × 3.5 h−1, p ˂ 0.03) and Condition 2 (2.1 ± 0.7 mmol L−1 × 3.5 h−1, p ˂ 0.05) relative to Condition 1 (4.6 ± 0.8 mmol L−1 × 3.5 h−1). Condition 3 (1.0 ± 0.7 mmol L−1 × 3.5 h−1, p = 0.02) and Condition 2 (1.6 ± 0.6 mmol L−1 × 3.5 h−1, p ˂ 0.04) attenuated post-dinner glucose iAUC compared with Condition 1 (4.0 ± 0.7 mmol L−1 × 3.5 h−1). Cumulative 10.5-h postprandial glucose iAUC was lower in Condition 3 than Condition 1 (p = 0.02). Condition 3 reduced 21-h glucose AUC compared with Condition 1 (p < 0.001) and Condition 2 (p = 0.002). However, post-breakfast glucose iAUC, cumulative 10.5-h postprandial glucose iAUC and 21-h glucose AUC were not different between Condition 2 and Condition 1 (p ˃ 0.05).Conclusions There could be dose-response between frequency of breaks in sedentary time and glucose. Interrupting sedentary time every 15 min could produce better glucose control

Developing an e-prehabilitation system of care for young adults diagnosed with cancer : user-centered design study

Background: A diagnosis of cancer in adolescence or young adulthood can pose many different and unique challenges for individuals, as well as their families and friends. Drawing on the concept of prehabilitation, the provision of high-quality, accessible, timely, reliable, and appropriate information, care, and support for young adults with cancer and their families is critical to ensure that they feel equipped and empowered to make informed decisions relating to their treatment and care. Increasingly, digital health interventions offer opportunities to augment current health care information and support provision. Co-designing these digital health interventions can help to ensure that they are meaningful and relevant to the patient cohort, thereby maximizing their accessibility and acceptability. Objective: This study had 4 primary interlinked objectives: understand the support needs of young adults with cancer at the time of diagnosis, understand the potential role of a digital health solution to assist in the delivery of prehabilitation for young adults with cancer, identify appropriate technologies and technological platforms for a digital prehabilitation system of care, and develop a prototype for a digital prehabilitation system of care. Methods: This was a qualitative study using interviews and surveys. Young adults aged 16 to 26 years diagnosed with cancer within the last 3 years were invited to participate in individual user-requirement interviews or surveys. Health care professionals specializing in the treatment and care of young adults with cancer and digital health professionals working in the industry were also interviewed or completed a survey. Consensus feedback interviews were conducted with 3 young adults and 2 health care professionals after development of the first generation of the prototype app. Results: Seven individual interviews and 8 surveys were completed with young adults with a range of cancer diagnoses. Six individual interviews and 9 surveys were completed with health care professionals; in addition, 3 digital health professionals participated in one-on-one interviews. A prototype app with the working name of Cancer Helpmate was developed based on these collective participant data. Overall, feedback from participants across the data collection activities suggests that the concept for the app was positive during these developmental stages. Further insightful ideas for the app’s future development were also identified. Conclusions: Young adults with cancer and health care professionals are responsive to the need for more digitally driven services to be developed. Further development of an app such as Cancer Helpmate, which incorporates key features and functionalities directly informed by users, could help to augment the support provided to young adults with cancer

Identification of B6SJL mSOD1(G93A) mouse subgroups with different disease progression rates

Disease progression rates among patients with amyotrophic lateral sclerosis (ALS) vary greatly. Although the majority of affected individuals survive 3-5 years following diagnosis, some subgroups experience a more rapidly progressing form, surviving less than 1 year, and other subgroups experience slowly progressing forms, surviving nearly 50 years. Genetic heterogeneity and environmental factors pose significant barriers in investigating patient progression rates. Similar to the case for humans, variation in survival within the mSOD1 mouse has been well documented, but different progression rates have not been investigated. The present study identifies two subgroups of B6SJL mSOD1(G93A) mice with different disease progression rates, a fast progression group (FPG) and slow progression group, as evidenced by differences in the rate of motor function decline. In addition, increased disease-associated gene expression within the FPG facial motor nucleus confirmed the presence of a more severe phenotype. We hypothesize that a more severe disease phenotype could be the result of 1) an earlier onset of axonal disconnection with a consistent degeneration rate or 2) a more severe or accelerated degenerative process. We performed a facial nerve transection axotomy in both mSOD1 subgroups prior to disease onset as a method to standardize the axonal disconnection. Instead of leading to comparable gene expression in both subgroups, this standardization did not eliminate the severe phenotype in the FPG facial nucleus, suggesting that the FPG phenotype is the result of a more severe or accelerated degenerative process. We theorize that these mSOD1 subgroups are representative of the rapid and slow disease phenotypes often experienced in ALS

Methods for combining continuously measured glucose and activity data in people with Type 2 diabetes : challenges and solutions

Aims: To present the novel application of combining continuously measured glucose with continuous accelerometer measured physical activity and sedentary behaviour data and discusses the principles used and challenges faced in combining and analysing these two sets of data in the context of diabetes management. Methods: The background and rationale for exploring glucose, physical activity and sedentary behaviour in people with Type 2 diabetes is presented, the paper outlines the technologies used, the individual data extraction and finally the combined data analysis. A case study approach is used to illustrate the application of the combined data processing and analysis. Results: The data analytic principles used could be transferred to different conditions where continuous data sets are being combined to help individuals or health professionals better manage and care for people with long term conditions. Conclusions: Future work should focus on generating validated techniques to visualise combined data sets and explore ways to present data back to the individual in an effective way to support health care management and rehabilitation

Building a research roadmap for caregiver innovation : findings from a multi-stakeholder consultation and evaluation

Across the world, informal (unpaid) caregiving has become the predominant model for community care: in the UK alone, there are an estimated 6.5 million caregivers supporting family members and friends on a regular basis, saving health and social care services approximately £132 billion per year. Despite our collective reliance on this group (particularly during the COVID-19 pandemic), quality of life for caregivers is often poor and there is an urgent need for disruptive innovations. The aim of this study was to explore what a future roadmap for innovation could look like through a multi-stakeholder consultation and evaluation. An online survey was developed and distributed through convenience sampling, targeting both the informal caregiver and professionals/innovators interested in the caregiver demographic. Data were analysed using both quantitative (summary statistics) and qualitative (inductive thematic analysis) methods in order to develop recommendations for future multi-stakeholder collaboration and meaningful innovation. The survey collected 174 responses from 112 informal caregivers and 62 professionals/innovators. Responses across these stakeholder groups identified that there is currently a missed opportunity to harness the value of the voice of the caregiver demographic. Although time and accessibility issues are considerable barriers to engagement with this stakeholder group, respondents were clear that regular contributions, ideally no more than 20 to 30 min a month could provide a realistic route for input, particularly through online approaches supported by community-based events. In conclusion, the landscape of digital health and wellness is becoming ever more sophisticated, where both industrial and academic innovators could establish new routes to identify, reach, inform, signpost, intervene and support vital and vulnerable groups such as the caregiver demographic. Here, the findings from a consultation with caregivers and professionals interested in informal caring are presented to help design the first stages of a roadmap through identifying priorities and actions that could help accelerate future research and policy that will lead to meaningful and innovative solutions

Children of the Twins Early Development Study (CoTEDS): A Children-of-Twins Study

The Children of the Twins Early Development Study (CoTEDS) is a new prospective children-of-twins study in the UK, designed to investigate intergenerational associations across child developmental stages. CoTEDS will enable research on genetic and environmental factors that underpin parent-child associations, with a focus on mental-health and cognitive related traits. Through CoTEDS we will have a new lens to examine the roles that parents play in influencing child development, as well as the genetic and environmental factors that shape parenting behaviour and experiences. Recruitment is ongoing from the sample of approximately 20,000 contactable adult twins who have been enrolled in the Twins Early Development Study (TEDS) since infancy. TEDS twins are invited to register all offspring to CoTEDS at birth, with 554 children registered as of May 2019. By recruiting the second generation of TEDS participants, CoTEDS will include information on adult twins and their offspring from infancy. Parent questionnaire-based data collection is now underway for one- and two-year-old CoTEDS infants, with further waves of data collection planned. Current data collection includes the following primary constructs: child mental-health, temperament, language and cognitive development; parent mental-health and social relationships; parenting behaviours and feelings; and other socio-ecological factors. Measurement tools have been selected with reference to existing genetically-informative cohort studies, to ensure overlap in phenotypes measured at corresponding stages of development. This built-in study overlap is intended to enable replication and triangulation of future analyses across samples and research designs. Here, we summarise study protocol and measurement procedures and describe future plans

Mind the gap: diversity and reactivity relationships among multihaem cytochromes of the MtrA/DmsE family

Shewanella oneidensis MR-1 has the ability to use many external terminal electron acceptors during anaerobic respiration, such as DMSO. The pathway that facilitates this electron transfer includes the decahaem cytochrome DmsE, a paralogue of the MtrA family of decahaem cytochromes. Although both DmsE and MtrA are decahaem cytochromes implicated in the long-range electron transfer across a ~300 Å (1 Å=0.1 nm) wide periplasmic ‘gap’, MtrA has been shown to be only 105 Å in maximal length. In the present paper, DmsE is further characterized via protein film voltammetry, revealing that the electrochemistry of the DmsE haem cofactors display macroscopic potentials lower than those of MtrA by 100 mV. It is possible this tuning of the redox potential of DmsE is required to shuttle electrons to the outer-membrane proteins specific to DMSO reduction. Other decahaem cytochromes found in S. oneidensis, such as the outer-membrane proteins MtrC, MtrF and OmcA, have been shown to have electrochemical properties similar to those of MtrA, yet possess a different evolutionary relationship.National Science Foundation (U.S.) (Grant MCB 0546323)National Science Foundation (U.S.) (Grant CHE 0840418)Research Corporation for Science Advancement (Scialog Award)National Institutes of Health (U.S.) (Grant F32GM904862

Can Volunteer Community Health Workers Decrease Child Morbidity and Mortality in Southwestern Uganda? An Impact Evaluation

BACKGROUND: The potential for community health workers to improve child health in sub-Saharan Africa is not well understood. Healthy Child Uganda implemented a volunteer community health worker child health promotion model in rural Uganda. An impact evaluation was conducted to assess volunteer community health workers' effect on child morbidity, mortality and to calculate volunteer retention. METHODOLOGY/PRINCIPAL FINDINGS: Two volunteer community health workers were selected, trained and promoted child health in each of 116 villages (population ∼61,000) during 2006-2009. Evaluation included a household survey of mothers at baseline and post-intervention in intervention/control areas, retrospective reviews of community health worker birth/child death reports and post-intervention focus group discussions. Retention was calculated from administrative records. Main outcomes were prevalence of recent child illness/underweight status, community health worker reports of child deaths, focus group perception of effect, and community health worker retention. After 18-36 months, 86% of trained volunteers remained active. Post-intervention surveys in intervention households revealed absolute reductions of 10.2% [95%CI (-17.7%, -2.6%)] in diarrhea prevalence and 5.8% [95%CI (-11.5%, -0.003%)] in fever/malaria; comparative decreases in control households were not statistically significant. Underweight prevalence was reduced by 5.1% [95%CI (-10.7%, 0.4%)] in intervention households. Community health worker monthly reports revealed a relative decline of 53% in child deaths (<5 years old), during the first 18 months of intervention. Focus groups credited community health workers with decreasing child deaths, improved care-seeking practices, and new income-generating opportunities. CONCLUSIONS/SIGNIFICANCE: A low-cost child health promotion model using volunteer community health workers demonstrated decreased child morbidity, dramatic mortality trend declines and high volunteer retention. This sustainable model could be scaled-up to sub-Saharan African communities with limited resources and high child health needs