Evaluating personalised eHealth interventions for people with dementia and their caregivers:Implementation, effects and cost-effectiveness of the FindMyApps intervention

This thesis presents research conducted to evaluate the FindMyApps eHealth intervention for people with dementia and their informal caregivers. The primary goals were to evaluate the effectiveness and cost-effectiveness of FindMyApps for promoting self-management and social participation of people with mild dementia, and sense of competence of their caregivers. Worldwide, the prevalence of dementia is growing rapidly. The individual and economic impacts of dementia are significant. People with dementia experience unmet needs around managing their own lives and engaging in social activities, despite these key aspects of social health being important to maintaining good quality of life. Informal caregivers of people with dementia experience worse health outcomes than people caring for friends or family with other chronic health conditions, and need support to provide good care. eHealth interventions are considered promising tools to address the urgent needs of both people with dementia and their informal caregivers. However, there are a number of barriers to implementing digital technologies for people with dementia, and there are very few studies which robustly evaluate the effectiveness or cost-effectiveness of eHealth tools for people with dementia. FindMyApps is a personalised eHealth intervention designed to support people with mild dementia and their caregivers to find and learn to use easy-to-use tablet-based apps, which meet their personal needs and interests. Behavioural theory supports an expectation that the intervention would lead to adoption of tablet apps, which have potential to improve self-management (through use of medicine reminders and diaries, for example) and social participation of people with dementia (for example, through video calling or instant messaging) and by unburdening the informal caregiver, improve their caregiver’s sense of competence (feeling able to provide good care). To evaluate the effectiveness and cost-effectiveness of complex eHealth interventions like FindMyApps, a randomised controlled trial design, including a parallel process evaluation and economic evaluation, is the gold standard. Conducting a gold standard evaluation of FindMyApps is the focus of this thesis. The thesis comprises a general introduction followed by eight further chapters: a systematic review and narrative synthesis of controlled studies evaluating effectiveness of digital technologies used by people with dementia; a pilot RCT comparing FindMyApps to regular tablet use; a protocol for a definitive FindMyApps RCT; a mixed methods process evaluation conducted alongside the FindMyApps RCT, following UK MRC guidance; main results of the RCT, reported in line with CONSORT guidance; results of a cost-effectiveness analysis; a study scoping the cognitive accessibility of privacy information associated with health and wellness apps; and a general discussion of the results of all the above studies. We conclude that whilst FindMyApps was not shown to contribute directly to better social health outcomes for people with dementia than a regular tablet, FindMyApps is a cost-effective tool for supporting caregivers’ sense of competence and should therefore be implemented by preference to a regular tablet. With respect to facilitators and barriers, it remains important to make eHealth interventions personalised, tailored to the needs of individuals and groups of users with specific needs, such as people with dementia. Methodological considerations and generalisability of the results of the research presented are considered, particularly noting the (potential) impact of the COVID-19 pandemic. Finally, recommendations for policy, practice and future research are made, with respect to FindMyApps and eHealth in dementia in general

A Flexible Framework for the Creation of Narrative-Centered Tools

To better support the creation of narrative-centered tools, developers need a flexible framework to integrate, catalog, select, and reuse narrative models. Computational models of narrative enable the creation of software tools to aid narrative processing, analysis, and generation. Narrative-centered tools explicitly or implicitly embody one or more models of narrative by their definition. However, narrative model creation is often expensive and difficult with no guaranteed benefit to the end system. This paper describes our preliminary approach towards creating the SONNET narrative framework, a flexible framework to integrate, catalog, select, and reuse narrative models, thereby lowering development costs and improving benefits from each model. The framework includes a lightweight ontology language for the definition of key terms and interrelationships among them. The framework specifies model metadata to allow developers to discover and understand models more readily. We discuss the structure of this framework and ongoing development incorporating narrative models

Post-Harvest Processing Methods for Reduction of Silica and Alkali Metals in Wheat Straw

Silica and alkali metals in wheat straw limit its use for bioenergy and gasification. Slag deposits occur via the eutectic melting of SiO2 with K2O, trapping chlorides at surfaces and causing corrosion. A minimum melting point of 950°C is desirable, corresponding to SiO2:K2O of about 3:1. Mild chemical treatments were used to reduce Si, K, and Cl, while varying temperature, concentration, %-solids, and time. Dilute acid was more effective at removing K and Cl, while dilute alkali was more effective for Si. Reduction of minerals in this manner may prove economical for increasing utilization of the straw for combustion or gasification

Impact of Clopidogrel Pretreatment on Ischemic Complications of PCI among Bivalirudin-Treated Patients: Results from the EVENT Registry

Computational Infrastructure and Informatics Poster SessionBackground: Although clopidogrel (CLO) pretreatment benefits PCI patients with acute coronary syndromes, these benefits are less well-established among elective PCI patients—particularly when treated with the direct thrombin inhibitor (DTI), bivalirudin. The effect of timing of CLO pretreatment on ischemic complications in these patients is also unknown. Methods: We used data from the multicenter EVENT registry to assess the association of clopidogrel pretreatment (600 mg 2 hr pre-PCI, 300 mg 6 hrs pre-PCI, or 75 mg/d for 1 week) with PCI-related complications in patients undergoing elective PCI with a DTI as planned antithrombotic. The primary endpoint was the composite of in-hospital death or MI (peak CKMB > 3 x ULN). Results: Between 01/05 and 12/07, 3568 pts underwent elective PCI and 1913 (54%) received DTI as planned anticoagulant (37% diabetics, age 65±10 y). Clopidogrel pre-treatment was used in 923 (48%). There were no differences in in-hospital or 1 year ischemic or bleeding events in relation to clopidogrel pretreatment in both unadjusted and adjusted analyses (see Table). There was a trend toward lower rates of death or MI with earlier pretreatment, however [Odds ratios vs. no pretreatment: >1 week 0.48 (95% CI 0.08 - 2.73); > 6 h OR 0.69 (95% CI 0.11 - 4.45) and 2-6 h OR 0.77 (95% CI 0.18 - 3.31)]. Conclusion: Among unselected patients undergoing elective PCI with DTI as the planned anticoagulant, clopidogrel pretreatment was common, but was not associated with a reduced risk of ischemic complications

The VIRUS-P Exploration of Nearby Galaxies (VENGA): Survey Design, Data Processing, and Spectral Analysis Methods

We present the survey design, data reduction, and spectral fitting pipeline for the VIRUS-P Exploration of Nearby Galaxies (VENGA). VENGA is an integral field spectroscopic survey, which maps the disks of 30 nearby spiral galaxies. Targets span a wide range in Hubble type, star formation activity, morphology, and inclination. The VENGA data-cubes have 5.6'' FWHM spatial resolution, ~5A FWHM spectral resolution, sample the 3600A-6800A range, and cover large areas typically sampling galaxies out to ~0.7 R_25. These data-cubes can be used to produce 2D maps of the star formation rate, dust extinction, electron density, stellar population parameters, the kinematics and chemical abundances of both stars and ionized gas, and other physical quantities derived from the fitting of the stellar spectrum and the measurement of nebular emission lines. To exemplify our methods and the quality of the data, we present the VENGA data-cube on the face-on Sc galaxy NGC 628 (a.k.a. M 74). The VENGA observations of NGC 628 are described, as well as the construction of the data-cube, our spectral fitting method, and the fitting of the stellar and ionized gas velocity fields. We also propose a new method to measure the inclination of nearly face-on systems based on the matching of the stellar and gas rotation curves using asymmetric drift corrections. VENGA will measure relevant physical parameters across different environments within these galaxies, allowing a series of studies on star formation, structure assembly, stellar populations, chemical evolution, galactic feedback, nuclear activity, and the properties of the interstellar medium in massive disk galaxies.Comment: Accepted for publication in AJ, 25 pages, 18 figures, 6 table

The VIRUS-P Exploration of Nearby Galaxies (VENGA): Survey Design and First Results

VENGA is a large-scale extragalactic IFU survey, which maps the bulges, bars and large parts of the outer disks of 32 nearby normal spiral galaxies. The targets are chosen to span a wide range in Hubble types, star formation activities, morphologies, and inclinations, at the same time of having vast available multi-wavelength coverage from the far-UV to the mid-IR, and available CO and 21cm mapping. The VENGA dataset will provide 2D maps of the SFR, stellar and gas kinematics, chemical abundances, ISM density and ionization states, dust extinction and stellar populations for these 32 galaxies. The uniqueness of the VIRUS-P large field of view permits these large-scale mappings to be performed. VENGA will allow us to correlate all these important quantities throughout the different environments present in galactic disks, allowing the conduction of a large number of studies in star formation, structure assembly, galactic feedback and ISM in galaxies.Comment: 7 pages, 3 figures, proceedings of the "Third Biennial Frank N. Bash Symposium, New Horizons in Astronomy" held in Austin, TX, Oct. 2009. To be published in the Astronomical Society of the Pacific Conference Series, eds. L. Stanford, L. Hao, Y. Mao, J. Gree

Fatigue in Medical Residents Leads to Reactivation of Herpes Virus Latency

The main objective of this study was to detect fatigue-induced clinical symptoms of immune suppression in medical residents. Samples were collected from the subjects at rest, following the first night (low-stress), and the last night (high-stress) of night float. Computerized reaction tests, Epworth Sleepiness Scale, and Wellness Profile questionnaires were used to quantify fatigue level. DNA of human herpes viruses HSV-1, VZV, EBV, as well as cortisol and melatonin concentrations, were measured in saliva. Residents at the high-stress interval reported being sleepier compared to the rest interval. EBV DNA level increased significantly at both stress intervals, while VZV DNA level increased only at low-stress. DNA levels of HSV-1 decreased at low-stress but increased at high-stress. Combined assessment of the viral DNA showed significant effect of stress on herpes virus reactivation at both stress intervals. Cortisol concentrations at both stress intervals were significantly higher than those at rest

Early Science with the Large Millimeter Telescope: COOL BUDHIES I - a pilot study of molecular and atomic gas at z~0.2

An understanding of the mass build-up in galaxies over time necessitates tracing the evolution of cold gas (molecular and atomic) in galaxies. To that end, we have conducted a pilot study called CO Observations with the LMT of the Blind Ultra-Deep H I Environment Survey (COOL BUDHIES). We have observed 23 galaxies in and around the two clusters Abell 2192 (z = 0.188) and Abell 963 (z = 0.206), where 12 are cluster members and 11 are slightly in the foreground or background, using about 28 total hours on the Redshift Search Receiver (RSR) on the Large Millimeter Telescope (LMT) to measure the $^{12}$CO J = 1 --> 0 emission line and obtain molecular gas masses. These new observations provide a unique opportunity to probe both the molecular and atomic components of galaxies as a function of environment beyond the local Universe. For our sample of 23 galaxies, nine have reliable detections (S/N$\geq$3.6) of the $^{12}$CO line, and another six have marginal detections (2.0 < S/N < 3.6). For the remaining eight targets we can place upper limits on molecular gas masses roughly between $10^9$ and $10^{10} M_\odot$. Comparing our results to other studies of molecular gas, we find that our sample is significantly more abundant in molecular gas overall, when compared to the stellar and the atomic gas component, and our median molecular gas fraction lies about $1\sigma$ above the upper limits of proposed redshift evolution in earlier studies. We discuss possible reasons for this discrepancy, with the most likely conclusion being target selection and Eddington bias.Comment: MNRAS, submitte